By Phil Giarth / Special to Healthcare Facilities Today

Healthcare leaders are gaining a clearer picture of the advantages of shifting toward a value-based healthcare environment where reimbursements are linked to quality of care rather than quantity of services provided.  With value-based payment models expected to account for 59 percent of healthcare payments by 2020, payers of all size are aggressively moving their provider contracts to value-based care. As a result, leadership teams at healthcare facilities nationwide are seeking tools to help them overcome key challenges and meet payer expectations.

When it comes to designing facilities in this changing landscape, it’s important to consider creating a space that puts the patient in the middle of care delivery in a way that addresses the “whole person.”  This includes accounting for social determinants of health (SDoH), with space allocations that allow for activities such as exercise and fitness, as well as areas set aside to address loneliness, food insecurities and financial stability.  

This new environment will require a robust EHR system for managing patients outside the walls of a hospital facility to include the home setting and other care facilities. It’s no longer simply a matter of designing structures to accommodate direct patient care for diagnostics and treatment – the environment should be expanded to incorporate areas that serve the needs of patients beyond the traditional medical care setting.

SDoH impact on outcomes

Experts believe that social determinants drive more than 80 percent of health outcomes, and that medical care alone fails to improve health. In fact, it is estimated to account for only 10-20 percent of the modifiable contributors to improved health outcomes. 

Furthermore, 68 percent of patients have at least one social determinant of health challenge, with 57 percent having a moderate-to-high risk for financial insecurity, isolation, housing insecurity, transportation, food insecurity and/or health literacy.

This is especially important in the management of Medicare and Medicaid patients where the SDoH challenges are even more pronounced and many patients may be compromised or disabled. These individuals lack social anchors or care in the home, since relatives and friends may have moved away or are not available. For this population, facing emotional and psychosocial issues is an ongoing challenge that impedes improved outcomes and quality of life. Chronic illnesses that require ongoing medical attention further exacerbate SDoH, especially when transportation to and from medical appointments becomes a primary concern.  

Managing the patient outside hospital walls

Value-based care is about managing the patient rather than simply the diagnosis, putting quality of care over volume of services.  The goal is to integrate social aspects of a patient’s health to decrease adverse events and optimize utilization.

Some of the most successful organizations have community/activity centers tied into their practices. Conviva, ChenMed, Iora and Oak Street Health stand-out as examples. These activity centers provide opportunity for much needed social interactions, as well as designated areas to engage and educate patients.  Such initiatives have shown significant performance gains and reduced emergency events. 

Conviva, for example, hosts an award-winning program designed to manage falls and increase activity levels for older patients and their caregivers who may be concerned about falling.  These types of issues and fears often restrict activity levels and contribute to feelings of isolation and loneliness. Another example is ChenMed’s Dedicated Senior Medical Center in Tampa which offers medications, X-rays, tests and screenings on-site, as wells as acupuncture, same-day appointments, when needed, and courtesy transportation. With these organizations setting an example, more healthcare leaders are rethinking how to design facilities in a way that offers these individuals a place to not only access care, but to also take advantage of every type of healthcare service they may need -- all in one location.  This spans primary care, specialists, pharmacy, physical therapists, social workers and more.   

Toward that end, healthcare facilities can become a one-stop shop, offering a welcoming haven for patients and catering to their health and wellness to avoid redundancy in care, enhance the patient experience and improve outcomes.

This new approach should also extend to the patient’s home where specialized experts can help patients ensure that their living environment is safe, comfortable and free of hazards that could lead to a catastrophic medical event. 

For example, consider the patient who had over 400 ER visits in one year. When his SDoH situation was addressed, it was found that the cause of this high utilization was because the patient’s house was very cold and he was allergic to his blanket. A simple fix – improving the home’s efficiency and getting him a new blanket – saved a significant amount of money and improved the patient’s health. 

Investing in EHR 

Critical to this process is an effective EHR to manage patient records. The traditional EHR is only as good as the information it contains, representing a single source of patient information, usually from the primary care physician (PCP). 

Once the patient seeks care from another provider, visits the ER or a specialist, the benefits of the EHR begin to break down and any health data generated by a provider or specialist will fail to reach the PCP. 

To maximize the value-based care opportunity, all EHR systems must be interoperable, with stakeholders freely sharing patient data in a two-way street. The absence of interoperability creates a burden for hospital systems and undermines payer efforts to achieve high quality care and low utilization. It also impacts reimbursement and profits – money that is better spent attracting new patients.

EHR’s can double as practice management systems (PMS), providing a sophisticated approach  to follow a supply chain management process called Little’s Law: the long-term average number of customers in a stable system, or “L,” is equal to the long-term average effective arrival rate, or “λ”, multiplied by the average time a customer spends in the system, “W.”

Applied to healthcare, physicians treat patients as they come into a facility, characterized as the long-term average number of customers. Physicians and the medical team are constantly tracking and providing feedback on abnormalities in the timeframe that patients spend in certain areas of the healthcare delivery system until they leave the facility, characterized as the long-term average effective arrival rate.  This is then multiplied by the average time a customer spends in the system. 

For example, a patient walks into the facility and signs in digitally, which is time-marked.  The system then tracks the patient’s timeliness for future events. A screen is displayed in the waiting room, monitoring average wait times for the day/hour and providing pivotal information to improve practice efficiencies, wait times and through put.

When this type of patient data can be shared easily across systems, it saves time, reduces provider burden and enables higher quality care and better value. Fortunately, solutions designed for value-based care are emerging based upon the concept that EHR is one of many tools necessary to help healthcare leaders and providers better understand and manage the cost and quality of care.

Browser extensions optimize EHRs 

Efficiently analyzing a patient’s medical records can transform data into insights, improve care delivery and health outcomes, add value and lower costs. The data can also alert care providers to a patient’s SDoH issues, enabling them to address broader healthcare concerns. 

To get the most from these capabilities, it’s now possible to maximize an EHR using a browser extension that is also a comprehensive, dynamic population health solution that creates a care, quality and risk continuum. The goal is to aggregate data from every possible source to illustrate the patient’s health status, needs and gaps in care to impact and manage risk. This demands an intelligent platform designed to drive value by reducing the cost of care, improving quality scores, ensuring risk adjustment accuracy and simplifying healthcare navigation.

Look for a web-based tool that is available at the point of care and has connectivity capabilities that allows EHRs to reach their full potential. The platform should give payers and providers insights that impact Medicare Advantage, Medicaid and commercial value-based care initiatives, is available as a Chrome browser extension and can operate on any web-based EHR.

The right browser extension enables providers to access all data from a single source, improve workflow and provide exemplary patient care. 

Key factors to look for include:

• Sits on top of any web-based EHR 
• Uses patient matching when on top of an EHR to pull the correct patient and their relevant data 
• Sends alerts to providers within their existing workflow
• Eases workflow and provider administrative burden by eliminating the need to toggle between different platforms

The best browser extension is designed to optimize the way information is shared, enhance how programs are implemented and improve care delivery. It eases workflow and provider administrative burdens by eliminating the need to constantly switch between different platforms, further streamlining the pathway to improved patient outcomes.

It should also provide insights to expedite the transformation to value-based contracting and risk-sharing for providers and their partners. Providers receive alerts within their existing workflow so they can remain compliant with all interoperability rules and regulations. 

The point of an EHR browser extension is to illuminate operational and clinical efficiencies, enhance connectivity, move clinical quality metrics and support risk adjustment accuracy. Most importantly, it creates patient engagement to drive better health outcomes and the best possible economic performance. 

Phil Giarth is the Director of Product for DataLink.