Dr Richard Snyder Discusses the Role of Data in Value-Based Agreements

Richard Snyder, MD, executive vice president of Facilitated Health Networks and chief medical officer at Independence Blue Cross, discusses the role of data exchange and analytics in value-based agreements.

Transcript

Can you have a successful value-based agreement without sufficient data exchange and analytics?

That’s an interesting question. I’m really very interested in this concept of data exchange. Payers typically have very broad but shallow information because everyone who provides care to a patient is looking to be reimbursed and that results in a claim, which gives us not necessarily clinical data but some insights in wherever that care is delivered. A patient may go to an institution that’s in a value-based contract for the delivery of the care but ultimately end up going to other sites of care—emergency rooms, urgent care centers, other physicians—to deal with potential side effects or complications, and those claims may not be in the view of the health system that’s part of the value-based contract. So, we think as a payer, we could bring a lot of information, both in the planning stages when you’re trying to establish what is the total cost of care for an episode or for the period of time that you’re taking accountability as a provider, but also to manage, on a real-time basis, those forays into other health systems.

We believe in combining that information with sort of the deep and narrow information that a health system has about a patient in their electronic medical record and using that to generate, through artificial intelligence type means and algorithms, identifying people who are at different levels of risk so we can manage them appropriately to get the most optimal outcome both from a cost, patient experience, and quality perspective.

In addition to that, I think health information exchanges (HIEs) can be incredibly helpful in that process. For instance, in Southeastern Pennsylvania, the health systems and the payers have come together to create the entity called Health Share Exchange in Southeastern Pennsylvania, which is an HIE that receives at ADT, or admission discharge or transfer, messages whenever a patient hits an emergency room, and admission, anywhere in our region. That ADT message can be directed to the treating physician or care manager within seconds of the patient hitting the emergency room or the hospital. That’s very useful to a case manager that’s trying to work with a physician or a health system to manage the care of the patient.

We’ve seen instances where upon immediate notification that a patient has arrived at an emergency room, that patient was picked up by the treating physician’s office or hospital and brought to their preferred treatment site, because obviously we don’t decide where the ambulance takes us when we call 911. It may not take us to our preferred doctor or hospital.

A second way that an HIE can be very helpful is to provide a treating physician in an emergency room that otherwise would not have information on a patient with up to 4 years of clinical history on that patient within seconds of the patient being registered in the emergency room. We have that in place here in Philadelphia. So, for example, if an University of Pennsylvania health system patient ends up at a different hospital, and they are not familiar with the patient, they can have a great deal of history available to them immediately when they see the patient, including the fact that they’re part of a value-based contract, which if people are playing nice in the sand, should result in collaborative and cooperative participation in taking care of that patient.