Value-based Payments Will Spur Radical Changes in Thinking and Technology

by Nick van Terheyden| @drnic1

The move to value-based payments will be the most significant trend of 2016, because it will force both caregivers and health plans to radically change the way they think and act. Population health, which emphasizes identifying risk and gaps in care, and filling those gaps, will be an existential capability for hospitals, physicians and health plans. If they get it right, they will prosper. If not, they will struggle at best or worse, wither and fail.

Effective population healthcare requires both a change in thinking and adoption of new technology for success. Organizations that have focused on episodic care and procedures to pay the bills will be the most challenged, because a completely new mindset will be needed.

If you are a surgeon who has been highly valued by a hospital because you bring in lucrative procedures, your life will change radically over the next couple of years.

  • Hospitals will be looking to physicians who can reduce costs and avoid the need for expensive interventions to help them succeed.
  • The surgeons (and other procedure-based specialties) will still be needed, of course, but they won’t have the rarified status in the future that they enjoy today.

Those who can find innovative ways to help patients improve their health status without a hospital stay or other expensive interventions will be the most successful in this new world.

Hospitals and physicians will also need to add technological capabilities to succeed. They will need to integrate data, analyze that data and use telehealth and remote monitoring to provide more effective use of resources and delivery of care. For many organizations, data integration probably seems overwhelming with too many applications speaking disparate languages.

The good news is that technology exists now which can create a nearly seamless interface among all these silos and allow data from a wide variety of sources to be used for population health, better treatments and more efficient operations.

Physicians will find a light at the end of the tunnel for those who hate their EHRs, as new vendors provide applications that make using an EHR simpler and more efficient. These vendors are creating applications that use the EHR and other clinical applications like a database, presenting patient data in a simpler, more clinically relevant user interface. This will mean that organizations can make their caregivers much more satisfied and efficient without having to ditch the huge investments they’ve made in clinical technology.

The next year will be a wild ride for many organizations, as they adapt to all these changes, but the work and effort should pay off in all kinds of important ways, liberating data for effective use in traditional clinical and patient care and unleashing innovation for its use and in new and unimagined ways.