Accountable Care Means Sharing Data Between Payers and Providers: You’ll Need More than an EHR

My Folder

I attended an accountable care organization (ACO) summit two weeks ago where several themes were prominent. If you’re paying as much attention to the accountable care trends as I am, they will sound familiar to you:

  • Current growth in healthcare expenditures is unsustainable
  • Incentives aren’t aligned between payers and providers
  • ACO models have in common the need to share risk for defined population of patients
  • Sharing risk requires managing costs through improving quality
  • Managing the health of entire populations must be the focus of new care delivery models
  • Sharing, storing and analyzing healthcare data is the foundation of population health management

ACO healthcare dataPopulation health management requires aggregation of data across every inpatient and outpatient episode of care and analytical tools that can address these trends. Certainly there is no lack of healthcare data to accomplish this task. The problem is that this data exists in silos. Disparate sources aren’t integrated.

Many healthcare enterprises believed that their Electronic Health Record (EHR) would be the silver bullet to this data problem, but they are beginning to discover the limitations of the EHR for managing at the enterprise-level all of the information necessary for effective risk-sharing. Health information exchanges (HIEs) help eliminate data silos but are not designed to store or analyze the data with the level of sophistication required for supporting a risk-sharing model. The reality is, until now, providers and payers have lacked consistent incentives to share data. That is the question that I want to address in this commentary.

Whose Healthcare Data Is It Anyway?

When healthcare organizations hold patient or member information in their systems, they consider it to be proprietary. But whose data is it really? The physicians’? The hospital or the clinic’s? The payer or the ACO’s? Medicare or Medicaid? Most people would agree that, rather than “belonging” to any of these entities, the data is the really belongs to the patient. And if it’s the patient’s, then the patient “owns” the data and all the other stakeholders are merely stewards.

Every definition I’ve seen shares the following characteristics:

  • Serve
  • Responsible
  • Manage
  • Supervise
  • Direct
  • Administer

My colleague, Eric Just, has written about why data stewardship is important. None of the definitions say anything about withholding or sequestering information. Today’s healthcare environment needs all stakeholders to act as true stewards of patient data and to act in the best interest of providing the highest quality of care to the patient. If patients are going to take on more accountability for their care, they need to have access to their own health data. If an ACO, payer or physician is going to take on accountability for outcomes of their care, they need to have access to the data. And if every stakeholder in the care process is accountable, they need access to the data.

Yet there still exists a tendency to limit access to healthcare data. Here are some of the typical rationalizations for limiting access:

  • “We need to protect patient confidentiality.” For example, a payer might claim that a patient’s mental health history has nothing to do with his cardiovascular problem. However, that information could help a provider understand why the patient isn’t compliant with his treatment plan.
  • “We need to limit legal liability.” Some organizations are concerned that if they share data—especially sensitive data—and is compromised by an unauthorized third-party, the patient will take them to court.
  • “The information isn’t relevant to that stakeholder.” For instance, payers or primary care providers might not see the importance of giving a dentist access to a patient’s health history.
  • “If they want the data, they’ll ask for it.” Some organizations would prefer to react to data requests rather than proactively share information.
  • “It’s too much trouble to share.” Many organizations have no electronic method in place to share data. Most data is still in hard-copy format, and a lot of faxes are going back and forth as you read this commentary. Sharing it is simply too much hassle for them unless someone specifically asks for it.

For Accountable Care, Change Is Necessary … and Happening

As stewards of the patient’s data, we have a responsibility to share that data appropriately to improve the quality and cost of care. Treating data as an asset that delivers a competitive edge to a payer or provider is no longer an option. Data should not be seen as a bargaining chip. Organizations do not have the right to withhold information that could impact the care of a patient or member who entrusts their healthcare to them.

Change takes courage, foresight and a lot of work, but it is happening. More and more, payers and providers are taking a progressive view about sharing data. One speaker at the ACO summit from a large Blues plan described how they insisted that they share all of their financial data with their providers to level the playing field. This attitude represents a major cultural change. Payers and providers are starting to cross the divide of the bargaining table. They are focusing on a form of collaboration where everyone starts on the same footing because they can access the same data.

The Role of a Healthcare Enterprise Data Warehouse

The willingness among payers and providers to share data is an exciting development. In many organizations, however, the technical barriers to aggregating data remain. Advanced technologies, such as a healthcare enterprise data warehouse (EDW), can remove these barriers. Expansion of the care-delivery model to population health management depends on integration of data from every touch point in the patient care process. An agile EDW—particularly one with a late-binding architecture that integrates new sources quickly and easily—is fundamental to data collection and analysis. With this foundation, stakeholders can not only share data, but also share important insights drawn from the data to improve the quality and cost of care.

Share My Healthcare Data!

I’ll end with a personal observation. As a healthcare consumer, I’ve often been frustrated by having to repeat my medical information to my providers and the lack of access to my health data that they maintain on my behalf. And it seems ironic in this age of electronic health records that I have to manually load the results of my lab tests and procedures into an app on my phone rather than having it available and updated automatically.

If you’re a hospital, payer, ACO, physician, pharmacist, dentist, skilled nursing facility … or any member of the healthcare continuum, please figure out how you can share my data. It will:

  • Improve your ability to provide and be accountable for my healthcare
  • Reduce your costs
  • Help save healthcare dollars

All healthcare consumers—including me—will thank you for your efforts.

What is your strategy for sharing data with payers, providers and other stakeholders? Are you participating or planning to participate in an ACO? How do you plan to aggregate and analyze the necessary data?