Healthcare Organizations Seek to Improve the Quality of Patient Care Through Payer-Provider Data Integration

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1 Healthcare Organizations Seek to Improve the Quality of Patient Care Through Payer-Provider Data Integration SPONSORED BY

2 n = 196 INTRODUCTION Problems within our healthcare system are well known and well documented. Many stem from the fact that our healthcare systems are not integrated. Today, most providers focus on single episodes of treatment rather than the patient s overall wellbeing, resulting in an overall lower standard of care for the patient and higher costs of care. This occurs because most providers do not have access to full patient information and the current payment structures do not support an integrated approach. By taking a more comprehensive approach and linking providers, insurers, patients, and communities, one would most likely improve the overall quality of patient care. In response to the problems discussed above, many healthcare reform initiatives have taken place over the last 20 years, building a framework of standards focusing on data coding, transmission of data, security, quality measurement, safety reporting, electronic health record implementation, meaningful use, accountability, and transparency. Included in the latest reform legislation, the Patient Protection and Affordable Care Act, there are attempts to reshape major facets of the country s healthcare industry, including new approaches to help align financial incentives. Many new payment methodologies are focused on rewarding those who have a more integrated approach to patient care. Levels of Participation in Programs That Integrate Payer and Provider Data Participating new Considering participation Plan to participate Not participating/no plans 0% 20% 40% 60% 80% 100% Although financial incentives like Pay-for-Performance (), CMS Core Measures, and the Physician Quality Reporting Initiative () are not new, by themselves they have not had a big enough revenue impact on healthcare providers to cause a shift in the delivery of care. With the creation of the Center for Medicare and Medicaid Innovation (CMMI), new legislation is not only looking at putting teeth into the older programs, but also developing new methodologies that more effectively compensate healthcare providers for integrated high quality care. Accountable Care Organizations (s) and are new healthcare delivery methods being piloted to promote coordination of care between physicians, hospitals, and payers. Most healthcare organizations lack access to essential data in order to provide patients with high quality coordinated care and to participate in these programs. The problem not only exists in Levels of Participation in Programs That Integrate Payer and Provider Data Accountable Care Organizations Currently participate 11% 19% Planning to participate 27% 35% Considering participating 17% 18% Not participating/no plans 44% 29% Bundled Payment Methodology Currently participate 42% 37% Planning to participate 17% 18% Considering participating 8% 18% Not participating/no plans 33% 28% Pay-for-Performance Currently participate 46% 45% Planning to participate 14% 24% Considering participating 13% 10% Not participating/no plans 28% 20% Physician Quality Reporting Initiative Currently participate 58% 64% Planning to participate 13% 19% Considering participating 8% 4% Not participating/no plans 22% 14% n = Healthcare Informatics Research SAS

3 The vast majority of current nonparticipating organizations have not evaluated these programs, which indicates a lack of information about the benefits to be gained. retrieving data from their own systems, but also in accessing data for healthcare services outside of their systems. So let s take a look at how providers are moving to meet the challenge of delivering high quality coordinated care at a lower cost, while also meeting the increased documentation required by federal mandates. Most Important Reason to Participate in Payer-Provider Data Integration Programs Improve quality of care 38% 42% Increase revenue 27% 8% Encourage cultural change 14% 9% Cost savings 6% 15% Access meaningful data 9% 8% Competitive 3% 12% Increase market share 3% 3% Another reason 2% No choice/mandatory** 1% n = 155 **Answer volunteered by respondents Integrated Payer-Provider Data Programs Of all hospitals surveyed with 200 beds or more, high percentages of providers are at least considering data sharing. Eighty percent (80%) are currently participating, considering participation, or planning to participate in, 78% in, 70% in, and 57% in s. A high percentage of respondents (61%) indicated they are already participating in and 45% are already participating in which, as mentioned in the introduction, is at least partially explained by the fact that these programs have been around longer than others. The percentage of multiple hospital systems participating in any of the programs versus single hospitals was higher in the all program types. Although only 15% of hospitals currently share data for purposes, many are planning to do so in the future, and 39% of surveyed organizations currently share data for bundled payment methodologies. At least 60% of hospital respondents are at least considering participation in s or bundled payments, which are currently being piloted by the Center for Medicare and n = 155 Medicaid Innovation. Most Important Reason to Participate in Payer-Provider Data Integration Programs Increase quality of care Increase revenue Cost savings Encourage cultural change Differentiate organization from the competition Access new, meaningful data Increase market share Another reason Did not choose/mandatory Improving quality of care is the most common reason that organizations cited when asked why they are currently involved or are considering participating in a program that integrates payer and provider data. Increased revenue is the second highest response; respondents in mid-sized hospitals cited revenue considerations more often than larger institutions. The vast majority of organizations currently not involved in specific programs also said they have not evaluated the benefits of such programs to date. However, about half or more say it is very or somewhat likely their organizations will participate within the next two years. For respondents 0% 5% 10% 15% 20% 25% 30% 35% 40% SAS Healthcare Informatics Research 3

4 in organizations that have evaluated the programs but choose not to participate, the two most common reasons cited for nonparticipation are uncer- Non-Participation in Programs Based on Evaluation...or Not No evaluations Evaluated/Opted not to participate tainty about program benefits and finance-related concerns. Respondents whose facilities were not participating in any programs were asked to cite the negative impacts from nonparticipation, if any. Giving up grants or additional payments and quality-of-care issues due to less sharing and integration of patient information were the top two areas of impact cited. 0% 20% 40% 60% 80% 100% n = 70 (). n = 59 (Bundled). n = 47 (). n = 34 (). Likelihood of Participating in Programs Within the Next Two Years Very likely Somewhat likely Not likely Project Leadership and Funding When it comes to project leadership, respondents cite the hospitals themselves as taking the lead in adopting the following types of programs: data integration, data visualization and analytics, reporting development, and ensuring access to information. This is particularly true for larger urban hospitals. Approximately 79% responded that they are funding most initiatives. Federal funding sources are a distant runner-up. Less than 20% of respondents cited government agencies as funding sources for initiatives. Hospital State/Government Agency Third-party 0% 10% 20% 30% 40% 50% 60% n = 104 (). n = 85 (Bundled). n = 69 (). n = 45 (). n = 172 Payer Another entity Project Leadership for Data Integration, Visualization and Analytics; Report Development and Access 0% 10% 20% 30% 40% 50% 60% 70% 80% Data integration Data visualization, analytics Developing reporting Ensuring access Conclusion To meet the challenge of improving quality of care, many healthcare organizations have taken on or are considering taking on the responsibility and the funding to participate in one or more programs that integrate payer and provider data. More established programs, such as the Centers for Medicare & Medicaid Services and, show higher levels of current participation, while more recent initiatives like s and bundled payments have fewer currently involved organizations; however more than half of mid- to large-size hospitals are planning to become s within the next two years. 4 Healthcare Informatics Research SAS

5 Project Leadership: Data Integration, Visualization and Analytics, Report Development and Access Data Integration Hospital 73% 85% State/Govt. agency 8% 6% Third-party 13% 6% Payer 4% 2% Another entity 1% 1% Data Visualization and Analytics Hospital 67% 84% State/Govt. agency 11% 5% Third-party 16% 5% Payer 5% 3% Another entity 1% 2% Developing reporting Hospital 72% 84% State/Govt. agency 12% 8% Third-party 13% 5% Payer 1% 2% Another entity 1% 1% Ensuring access to the reporting by all parties Hospital 73% 75% State/Govt. agency 12% 13% Third-party 8% 6% Payer 5% 4% Another entity 1% 2% n = 77 ( ). n = 98 (500+). Funding Sources for, Bundled Payment,, Initiatives Accountable care organizations Hospital 80% 72% Federal funding 17% 20% Third-party funds 4% 9% Payer 4% 7% State funding 7% 7% Bundled payment methodologies Hospital 68% 72% Federal funding 20% 17% Payer 17% 13% State funding 10% 4% Third-party funds 5% 8% Physician Quality Reporting Initiative Hospital 81% 82% Federal funding 16% 14% Payer 6% 8% State funding 6% 7% Third-party funds 2% 7% Pay-for-performance programs Hospital 67% 68% Federal funding 25% 19% Payer 18% 16% Third-party funds 10% 12% State funding 10% 7% n = 133 (s). n = 154 (Bundled payment). n = 181 (, ). Funding Sources for, Bundled Payment,, Initiatives s Bundled Payment Methodology and Survey Respondent Demographics A total of 418 interviews were completed with healthcare providers who are part of the Vendome panel. Within that group and included in this whitepaper, 196 were represented by mid- and largesize hospital organizations with 200 or more beds. Mid-size hospitals with 200 to 499 beds represent 45% of the organizations that participated. Large hospitals with 500 or more beds accounted for 55%. Invitations were first sent September 7, 2010, and the survey was closed September 20, Hospital Federal funding State funding Third-party funds Payer 0% 10% 20% 30% 40% 50% 60% 70% 80% n = 133 (). n = 154 (Bundled). n = 181 (, ). SAS _S Healthcare Informatics Research 5

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