Health plans need to better use tech to simplify quality initiatives

Value-based care depends on measuring and reporting outcomes, but doing so is causing burnout in physicians.

That additional challenge for physicians comes despite widespread efforts to reduce this burden, according to a new survey of 23 health plans conducted by Harrisburg, Penn.-based Geneia, an analytic solutions and services company.

Part of the problem lies in the fact that there are more than 500 provider quality measures—with little overlap between the measures that insurers need or the 1,700 measures used by government agencies, Geneia says.

“It is no surprise that 86 percent of physicians cite the ‘heightened demand for data reporting to support quality measures’ as a top driver of physician burnout, and view multiple and duplicative quality measures as one of the main barriers to accepting downside risk and moving into value-based care arrangements,” authors of the study say.

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"Undoubtedly, healthcare quality matters and measuring quality performance does too," says Shelley Riser, Geneia's vice president of consulting services and clinical innovations. "There's also no doubt that we can—and must—do much better in reducing the burden of quality performance on health plans and their physician partners."

In its new report, titled, “Take Control of Quality Performance: Three Proven Strategies for Health Plans,” Geneia takes the findings from the survey offers these three tips on how to health plans can better manage data collection and help physicians stay in it for the long haul in value-based care.

Establish a robust rules management hub. Geneia recommends that payers establish a single home for rules management, powered by a robust rules engine. Despite all the technological advances available, too many health plans—and even hospitals and physicians—are still compiling, tracking and reporting quality measures manually on spreadsheets. These spreadsheets work, “to a degree,” but they are error-prone and time consuming. A rules management center can serve as a quality hub for contractual and organizational rules and can create harmony across the entire enterprise, Geneia says.

When it comes to rules, Geneia recommends that business, quality and clinical rules be easy to modify on a repeated basis, and they should be agile when it comes to customization and usability. “To keep pace with constant regulatory and market changes, end users with little clinical or technical expertise must be able to quickly change and update rules,” Geneia says. Rules should be housed, viewed, manipulated and shared from within a single data platform to facilitate faster data collection and analysis.

Optimize member engagement with predictive analytics. Every encounter members have with their health plan can be used to build the payer-member relationship, close gaps in care, educate and connect members with providers, Geneia says. To improve quality of care through this avenue, Geneia recommends that payers use a strategic approach for member engagement that combines predictive analytics with education, screening and enrollment activities.

Establish thoughtful clinical integration. Integrating clinical and claims data contributes to closing gaps in care and helps to manage the cost of care. “It isn’t enough to accurately identify gaps in care or have world-class predictive insights,” Geneia says. “Strategic and ongoing quality improvement can only happen when health plans and their value-based partners easily share information back and forth. Having clear, concise access to this information—at the point of care—is key to success in quality-based care and overall population health management.”

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