| February 12, 2017
| 5:32 AM
A 2016 national research study by ORC International and commissioned by McKesson found that the industry has arrived at a tipping point toward full value-based payment.
McKesson experts Tomer Levy, general manager, workflow and infrastructure; Billie Whitehurst, vice president, capacity management and extended care solutions; and Andrei Gonzales, MD, associate vice president, value-based reimbursement initiatives; discuss this increasing pace to value-based care models. They stress the importance of interoperable technology to accelerate that progress in order to achieve better and more efficient care delivery and improved health outcomes.
What progress is the industry making in the transition to value-based care?
WHITEHURST: The good news is that we see movement on a number of fronts. There’s a focus on quality and measurement of those quality systems and the tools to support a sustaining process. We’re also starting to see partnerships across care settings in the payer demonstration projects, and we’re seeing new key roles to support the programs, like navigators, CNIOs and individuals focused on data. We’re also seeing providers bring patients/consumers into the process and offer them transparency and choices.
Payers and providers alike continue to report they are struggling to scale. Why is this and what’s your advice for success?
LEVY: Scaling is challenging for every organization because it means change. Things don’t work the same when you scale up –different tools, processes and organizational designs are needed. Expectations and requirements from technology change as well. Traditionally in imaging, organizations have tried to meet the challenge by moving all parts of the enterprise onto the same PACS system. But unfortunately this strategy proves to be very difficult for health systems because it requires a heavy technology lift and a major disruption to the clinical workflows. And, of course, it is a never-ending process because organizations are constantly changing, acquiring other organizations and creating new business models. To ensure success, vendors need to step up. Instead of offering system replacement as the only option, they need to offer more flexible, more adoptable – and more interoperable – technology that will help organizations achieve their goals of performing better and delivering results at lower costs.
What can organizations do to remove some of the barriers to interoperability?
WHITEHURST: Providers should use their leverage to help move the industry along. They should include interoperability in their RFPs and evaluation processes and be willing to adopt standards rather than their own custom approach.
LEVY: I agree with Billie. Providers need to demand interoperability from technology vendors. If they won’t demand it, the industry won’t get to where it needs to be.
What are vendors like McKesson doing to help?
WHITEHURST: At McKesson, we are absolutely working with the industry and our customers to make interoperability a priority. We are working with our customers to leverage things like predictive analytics and workflow management systems to meet shifting patient demand. We are working with other vendors and our customers to make sure our systems are interoperable, so we can provide data that is able to be consumed and then used by those clinicians and administrators who can actually act on it.
LEVY: McKesson is committed to interoperability and to the success of our customers. One way we demonstrate our commitment is that all our solutions and products are interoperable by design. That means, operationally, they are not tied to just McKesson systems – they are designed to interact with other systems as well.
GONZALES: The industry talked about interoperability for a long time, but change was slow. Now we are seeing a cultural change – more openness in the industry as a whole. We’re all getting very specific about product roadmaps and timelines, and formulating the goals and objectives to get there. And there’s more collaboration among payers, providers and vendors. At McKesson, we’re helping to facilitate this collaboration with our technology platform for interoperability, which makes it easy to share business intelligence between payers and providers and, as a result, makes automated reimbursement as streamlined as it can be.
What specific steps should payers and providers take to make sure they are on track with the CMS mandates and goals for payment tied to value?
GONZALES: It comes down to two things: collaboration and truly understanding the benefits. It’s important for payers and providers to collaborate in their local market and understand the goals of the value-based transition and how this focus on outcomes will benefit their patients, their businesses and others. That collaboration is necessary to figure out what types of models they’ll implement and the details of how they’ll implement them so the benefits of cost and quality are there. By moving to these value-based models, measuring their success and being able to communicate that success, organizations can start to see how they can differentiate themselves in competitive markets. They can show patients, other providers and health plans they’re achieving higher quality, in networks and getting the patient volumes from those plans. Once organizations understand those benefits, they can start to make those models part of their overall strategy and operational plan, and get behind the movement rather than seeing it as being forced on them.
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