Top data challenges in designing a value-based care network

Selma Chang
February 16, 2021

Two key data challenges in designing a value-based care network

A value-based care network is a promising opportunity to manage costs and improve health outcomes, but to get there, payers have to develop and manage risk-based reimbursement networks effectively. The success of these networks often hinges on the relative strength and value of each organization.

Given the potential upside, it’s unfortunate how often recurrent challenges undermine these efforts, and they share a common point of origin: data.

Let’s break down a couple of the obstacles payers face when designing high-performing networks, then unpack how they’re impacting business and member outcomes alike.

Lack of comprehensive provider supply insights

Developing a high-performing network to meet value-based contracting requirements requires a careful assessment of population needs and provider supply in the market. Understanding the provider landscape in a given market can give payers powerful insights into factors that can inform how networks should be structured to drive the most value for members. But the process of assessing and deriving insights about provider supply is a daunting challenge.

Across public databases alone, there are thousands of data sets available. Tracking down and consolidating all of that information into a single source of truth remains a significant pain point. Even when organizations opt to take on the challenge of creating a proprietary database, the data can quickly become stale. Providers may change health system affiliations, physicians might change locations, and more, which means that healthcare organizations must validate the data, augment, and update it in an ongoing, scalable way.

Therein lies the crux of the challenge — developing the infrastructure to build and manage such a database takes an incredible amount of time and resources.

Assessing provider supply is no easy feat, but without that analysis, members ultimately bear the brunt of the impact.

No single source of truth for provider performance metrics

Today, most value-based care providers are capturing and tracking provider quality and performance data from multiple sources: the Centers for Medicare & Medicaid Services, online review sites, provider oversight bodies, and more. These data points are highly actionable because they offer objective information about the value that a provider can bring to members. It’s also a way for payers to ensure that their members are always getting the highest quality care.

There’s just one drawback, though — one that echoes the challenges outlined above: The data is inconsistent, scattered, and siloed.

Addressing this should be a business imperative for value-based care contracting. However, with competing organizational priorities and technical resources often already stretched thin, building an integrated database to house all of this data just isn’t feasible. Again, that can have severe consequences for the network’s efficacy and on member outcomes.

The downstream impact in focus

Where does this unfortunate state of affairs leave us? And no less critically, what are some of the consequences on healthcare consumers, particularly vulnerable populations?

Let’s start with the former. When healthcare organizations don’t have access to comprehensive, accurate, and timely data, the negative consequences quickly add up. For example:

  • Decision-makers aren’t aware of emerging weaknesses, critical gaps, or opportunities to strengthen market share.
  • The incentives associated with contracts or programs don’t line up with the broader organizational strategy or priorities.
  • Reduced bottom-line benefits from value-based care programs and contracts, especially over the near term.

Outcomes like these can significantly impact organizational growth, but worse, they risk fundamentally compromising the quality of care for members. Holistically, these implications can even negatively impact the efficacy of healthcare delivery overall. Consider that, as multiple studies show, value-based care programs can effectively motivate hospitals to reduce their readmissions rates, for example. When payers and providers are operating with—and making critical decisions based on—a fragmented, partial, or siloed data ecosystem, that’s far less likely to happen.

Moving towards better access to data for network design

What can healthcare organizations do to move beyond these challenges and avoid some of the costly ramifications addressed above? The answer is access to better data.

To learn more about the impact of access to comprehensive, accurate, and timely providers, download our ebook Simplifying Healthcare Navigation.

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