The shift from volume-based care to value-based care is well underway. Value-based care emphasizes the proactive delivery of high-quality healthcare to patients by a well-coordinated team of clinicians. With this shift, the focus is on the quality and efficiency of care, not the quantity of services provided.
For value-based care to succeed, both clinical and provider data must constantly be monitored and managed. Under value-based care models, providers are evaluated at a more granular level than they are in volume-based (aka fee-for-service) models. This means the data flowing between payers and providers is more important today than ever before. Payers and providers have the opportunity now, while value-based care is still catching on, to improve the flow and management of data for more aligned collaboration.
The need to align health plans and providers
As the healthcare industry continues its transformation from volume- to value-based care, the relationship between payers and providers will need to transition to a team approach that is focused on improving health outcomes. And teams share critical information, like data, with each other. Seventy percent of providers believe that value-based care cannot be successful without seamless data sharing between payers and providers.
Without accurate clinical data, providers won’t be able to identify the various services their patients need and communicate this information to payers. Without accurate provider data, payers won’t be able to determine which of their high-performing providers are deserving of their value-based care rewards and payouts. Better managing the critical data that payers and providers need to communicate about patients and make payments efficiently is a crucial step toward achieving their mutual goal: providing high-quality care to patients.
Finding common language in common data
Claims processing was already a major component of the payer-provider relationship in the volume-based care model, and it becomes even more important in value-based care as claims become less frequent (hopefully) but more meaningful. Yet, if the early steps of the claims process — credentialing, verification, and enrollment — are not completed accurately, the precedent for data sharing and interaction between payers and providers can set a negative tone in the relationship.
Utilizing common tools to manage data is one way to ensure accuracy and help build a sense of partnership between payers and providers. By using a common data source, payers and providers can move toward the seamless data sharing they need for the delivery of value-based care instead of thinking on a “per-transaction” basis. Essentially, the shift in thinking about each individual transaction to looking more holistically doesn’t just apply to the care; it applies to the data too. For example, credentialing, verification, and enrollment are usually viewed as separate tasks. But in the aggregate, they largely involve the same data shuffled around. Why wouldn’t providers and payers work toward one provider data ecosystem? With this single-source and free-flowing data approach, it becomes easier to apply tools that push and pull data seamlessly, enabling a more efficient transaction process and freeing up resources to be reallocated toward the clinical aspects of value-based care.
More efficient processes for managing provider data benefit payers, providers, patients, and the industry as a whole. The amount of waste seen in the healthcare field continues to grow year after year. There’s a missed opportunity to save $16.3 billion by improving the way payers and providers share data. Data has become, and will continue to be, the center of healthcare. The sooner these two entities can become partners and find the most efficient way to share their data, the sooner we’ll all move closer to providing high-quality care without disruption.
