How will therapy management software look like in value based care?
Value based care is about placing the value generated by healthcare practitioners as the basis for payment as opposed to a fee-for-service model. The triple aim of value based payments is to improve care for individuals and population, at a lower cost. Value based payments can take many shapes and forms: bundled payments for episodes of care, shared savings and risk, capitation or population payments and more. The bottom line is similar, practitioners will get paid based on measured outcomes of their patients and their families, rather than on the number of sessions provided. The motivation is to achieve better results at a lower cost. And the control over such ‘budgetary’ decisions is moving from policy makers and payers to therapists, practice owners and other managerial staff of providers.
With that added ‘power’ over care-path decisions, practitioners will need a whole new set of tools to support them. Occupational therapists and speech-language pathologists in pediatric clinics, physical therapists in rehab centers, behavioral therapists in autism facilities, psychologists in private practices and many more — are going to be empowered to make such budgetary decisions over care-path. And their ability to get paid, win financial rewards or suffer penalties, will depend on their evidence based care-path decisions. That is a huge change! It goes far beyond adding new codes (not that that’s easy…). It changes the basic fundamentals of how practitioners engage their patients, and how they get paid in the short, as well as the long term. EMR providers that take pride in their scheduling, billing, documentation and related services will need to evolve and develop new capabilities in order to remain the go-to vendor for providers’ software solutions in the era of value based care.
These changes will need to encompass 4 main areas:
Patient engagement
Therapy in the value-base era will have to rethink the concept that value is generated mainly in-session. Empowering patients and clients to carryover between sessions (aka generalization), is going to shift from a ‘nice-to-have’ to a ‘must-have’ thing. Practitioners that will look to significantly reduce costs while improving measured outcomes, will have no other choice than to optimize in-session and inter-session interventions. That’s the only way, and it’s not necessarily a bad thing.
Inter-session patient engagement is also well aligned with the patient and family centered approach. This means that adding a new patient engagement module to the EMR is not going to be the ask of practice owners and managers only. If done right (see next paragraph on evidence base) it is actually going to gain a strong professional support from practitioners themselves. Just imagine, they will now have a tool to amplify their impact beyond the in-session time they spend, and they’ll get paid for it! An experienced practitioner will be able to multiple her efficiency. Instead of working in a 1:1 relationship of time to impact to payment, she will now have a chance to augment 1 weekly session of therapy with plenty of inter-session work carried out by the patient and/or caregivers, and if she manages that properly (i.e. monitors adherence and tracks outcomes) she can actually get paid for that work.
And with the fast growing millennial segment, we also see a strong ‘pull’ for apps and gadgets that can help improve patient engagement. Making patient engagement a tool that aligns managers’ goals around resources utilization, with practitioners’ goals around evidence based interventions, with patients’ demand for innovation and 24:7 real-time support. With value added to all three types of players — providers, practitioner and patients/caregivers — we can safely expect that patient engagement technology will play a key role in value based payments. And the players that will deliver such solutions to all 3 segments will set the tone for how value based care is going to be managed.
Evidence base
Evidence base is usually in the realm of professional education, research and clinical practice. What does it have to do with EMR? The shift towards value based payments places evidence based practice in the critical path of value based EMRs. As we saw above, value based care changes how care path decision are being taken. Instead of having a practitioner fill out evaluation and assessment reports in order for her patients to be eligible for reimbursements she now has to make her own decisions regarding eligibility. Providers are given a total budget to manage per individual and population care path, and their decisions will impact their payment. Making the quest for evidence-based best-practices something that affects not only the ethical / professional aspect but also the direct financial one.
This will blur and redefine the borders between the professional therapeutic side and the administrative financial one. EMR vendors that will skill to realize this sooner will have an advantage in generating ROI for their customers. Just imagine a value based EMR system that helps make care path decisions based on evidence-based protocols leading to shared savings and rewards for the provider. No longer will EMR vendors have to show only administrative productivity to justify their value proposition. New avenues will open up to generate financial gains for providers, adding value in care-path decision support.
Evidence base also solidifies the use of patient engagement tools. Since patient engagement tools are used to increase adherence with inter-session practice and generalization, they need to be studied and researched just like any other aspect of the intervention. It will not be enough to provide a nice software that does patient engagement and expect to gain the professional support from practitioners. EMR platforms that will be able to show evidence base that backs their patient engagement capabilities, will prevail to win the support of professionals and not just administrators. eHealth studies today are already making the distinction between adherence promotion and health outcomes. Vendors that will seek to lead the industry in the value based care age, will need to master evidence based capabilities.
Outcome measures
One cannot provide value based care without agreed upon measured outcomes. Value based care ties payments to results, so results need to be measured and agreed upon. That’s not a small thing. Especially in face of the growing number of diagnoses, disorders and interventions. And if personalized medicine will ever expand to genetic based therapy, things will get even more complicated. Yet, the information about new disorders and interventions already exists. The wisdom of crowd holds it. We just need to collect and serve it. The network advantage of this knowledge will most likely go to the first mover to effectively pool this data.
This wide array of measurements per each discipline leads to some attempts to standardize. while it’s still early to say how much can be standardized, one thing is sure: new technologies can help gather objective measures as well as improve accuracy of subjective PRO (patient reported outcomes) by collecting them in real time. Wearable technology, home sensors and even mobile apps can all collect huge amounts of data. Advanced machine learning algorithms can help make sense of this big data. Leading to objective outcomes measures that can feed into care path decisions. While PRO’s often suffer from desirability and other biases, studies have shown that such biases can be reduced significantly when using electronic measurements such as app, in real time.
Value based practitioners will seek technology that helps make care path decisions that gets them paid. And if value based payments are going to be tied to outcome measures, wouldn’t it make sense to have the billing / payment module and the outcomes measures module part of the same integrated platform?
Interoperability
One of the underlying hopes of policy makes is that bundled payments for episodes of care will force providers to collaborate. Hospitals and rehab centers need to exchange data in order to make holistic care path decisions that optimize total spending across the different entities. While it still remains to be proven whether bundled payments will actually lead to more cooperation, it is clear that therapy EMRs especially in rehab will need to accommodate such collaborations.
Similarly, collecting objective measurements on outcomes from the ever growing number of apps and IoT (Internet of Things) wearable and home-based sensors requires good APIs (one and two-way). These are not just technical challenges; these are business challenges. And because they involve 3rdparties, and because things get even more complicated under HIPAA, I’d dare to guess that true value generating interoperability, is still a pretty long way out.
Summary
Value based care is dramatically changing how practitioners are engaging their patients and how they get paid for it. Value based payments empower providers to make care path decisions that will have direct financial impact on their practice. Software vendors that provide support to therapy practices will need to evolve into value based EMRs in order to remain valuable. The 4 main areas where EMR vendors need to grow are: patient engagement, evidence base, measured outcomes and interoperability.
Patient engagement will enable to reduce costs by optimizing in-session with inter-session work, amplifying practitioners impact by opening the door for them to get paid for results beyond in-session time. Evidence-based care-path decisions will generate value-based ROI that goes beyond administrative productivity, and win the professional support of practitioners in patient engagement modules. Measured outcomes can pool crowd wisdom in the expanding blue ocean of new disorders and interventions, while utilizing technology for objective measures and reduced biases of PRO. Interoperability is part of bundled payment collaborations around episode of care, yet it faces significant challenges ahead.
Talks about value based payments are already leading practitioners to seek for solutions that help them increase patient engagement and improve measured outcomes, in an evidence based approach. Vendors that will skill to offer such solutions, interoperable with scheduling, billing and other EMR features, will most likely lead the market going forward.
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Originally published at orensteinberg.com on April 24, 2017.
