Value-Based Payments: But Is There Any Value for Doctors?

Leigh Page


October 08, 2015

In This Article

The Importance of Robust Data

Dr Holly says having the right data is key to his practice's success in managing value-based contracts. "Before you know where you want to go," he says, "you need to know where you are." He even puts his doctors' individual performance measures on SETMA's internal website for the physicians to see.

The SETMA system provides the physician with a "cluster" of actions to take for each diagnosis. After completing a patient encounter, the computer will show whether the physician has met clinical guidelines. For instance, when a high blood pressure count is entered, the system provides a set of quality targets for elevated blood pressure.

"Because the clusters are produced without any effort on the provider's part, they don't add to the provider's work," Dr Holly says.

But creating this intuitive information technology (IT) system required a lot of time and money. Over the past 18 years, SETMA has spent more than $9.5 million on its own homegrown healthcare IT system, which is managed by a staff of six.

Insurers often provide practices with value-based metrics that are based on their claims data, but Dr Holly says the data aren't as accurate as a practice's own data from its medical records, and relying on the payer's data creates a dependent relationship, making it impossible to develop your own value-based goals.

Many doctors, however, feel intimidated about creating their own data. "Outcomes and performance metrics are a central feature of value-based care, but many physicians aren't able to harness their own data," Woodcock says.

Indeed, doctors need a lot of help with IT, according to a 2015 RAND Corporation survey[3] for the American Medical Association. "Physician practices...are finding that they need help with successfully managing increasing amounts of data and figuring out how to respond to the diversity of programs and quality metrics from different payers," RAND reported.

A new Maryland-based company called Aledade is trying to address this need. Headed by Farzad Mostashari, MD, the former national coordinator for health information technology at the Department of Health and Human Services, Aledade helps physicians found their own ACOs and then stays with them to help run their data.

The company is assisting 100 physician practices in launching Aledade-branded ACOs in 10 states. Solo family physician Jennifer Brull, MD, is joining the Aledade ACO in Kansas, which was launched on May 9. "Aledade has a large amount of venture capital and covers the start-up costs," she says.

She has her own electronic health record (EHR) system, which she shares with several other small practices, but she needed a more robust system to work in new value-based arrangements, such as ACOs. "Aledade does the data analysis, so our EHR doesn't need to be changed."


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