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Just as we get ready for HIMSS comes the same old song but with new urgency, new wording –and a way out. Harkening back to a prior U.S. President, it can be summarized as, “It’s the interoperability, stupid.”

That won’t exactly be news to anyone at HIMSS next week, but this time the warning comes from the Healthcare Financial Management Association (HFMA), and their proof delineates a solution.   The organization’s survey, sponsored by Humana, suggests that we need to redefine “interoperability” to be more than the sum of its parts. It must mean a true, interactive network.

Or else we won’t know what to do with data we already collect. For example, “The majority of organizations that have access to social determinants of health [such as food insecurity] report that they don’t leverage this data,” according to Health IT Analytics, in its account of the survey.  “Only 37 percent said their organizations consider social determinants in their overall strategy and cost planning.”

That number is sure to increase as organizations adopt value-based models and look for non-clinical factors that affect patients’ health. “Interoperability has the challenge of collecting fragmented health data and exchanging the information across multiple systems,” observes Roy Beveridge, MD, Humana’s Chief Medical Officer, essentially describing an interactive network.

“In addition,” he says, “it must provide physicians access to comprehensible patient health information at the right time for informed decision making and better efficiencies.”

HFMA, based in Cook County, Ill., is a non-profit organization of more than 39,000 healthcare financial management executives.  Among the findings in its survey of members:

  • Data sharing/interoperability problems appear to have slowed implementation of value-based care. In 2015, an increase of 50 percent adoption was predicted within two years. Adoption rates have instead has instead ranged from 12 to 24 percent.
  • 74 percent of respondents cite interoperability – “capabilities for aggregating clinical information across networks and between hospitals and physicians” — as an “extremely important need.”
  • Significant challenges related to value-based payment include lack of staffing and financial resources, and lack of physician “alignment and support.”
  • We’re getting older and, as a result, sicker; 55 percent of respondents anticipate need for improved chronic care management within three years.
  • It’s going to get worse. As the population ages, “overcoming the interoperability barrier becomes even more important for treating patients with chronic conditions, as [seniors] generally see multiple physicians and specialists,” says Beveridge.
  • Existing solutions fall short, or are out of reach; 35 percent say they don’t have the tools or technology needed to control costs of specialty or inpatient care.
  • On the plus side, “positive financial results” (return on investment) for organizations using value-based care models have grown from 51 percent to 74 percent since 2015.

And, finally, to help accelerate adoption of value-based care models, researchers suggest that health plans and payers increase data sharing, act as partners with providers, and standardize their programs and processes.”

(By an amazing and unheard of coincidence, this is exactly what Moxe Health does. What are the odds?)

“Collaboration among health systems, physicians, and health plans is the key to growing value-based payment,” says HFMA president and CEO Joseph J. Fifer, FHFMA, CPA. “Technology and other obstacles can be overcome if all stakeholders commit to working together for the benefit of the people we serve.”

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