Editor’s Note: In the February issue of PharmaVoice, Manatt Health examines how the ACA is driving faster transformation of the healthcare delivery system. Key points are summarized below. Click to download the full article.

The ACA is accelerating a reorganization of the healthcare delivery system from episodic, reactive, acute management of patients to proactive, population-based delivery models. This transformation requires both payers and providers to manage high-risk patients and chronic diseases aggressively, identify risk factors and engage patients in self-management. All of these tasks demand accurate, timely, secure information, available to both patients and providers. Organizations able to manage the heavy flow of information needed to optimize health outcomes, contain costs and support high-needs patients while keeping less complex patients healthy will gain more market share.

The Importance of Data Convergence

Current medical record systems do a good job of digitizing health data, and their adoption has been rapid. The number of hospitals using electronic health records soared from 9.4% in 2008 to 44.4% in 2012.

Other tools are needed, however, to support population-based care delivery models. Registries, analytics and business intelligence systems are being deployed to:

  • Identify high-risk populations,
  • Apply protocols for prompting patient outreach,
  • Assess treatment pathways,
  • Report measures internally and externally to inform decision making, and
  • Demonstrate value to health plans and purchasers.

Effective implementation across all of these applications requires a convergence of clinical, financial and utilization data into a single data stream that can be mined across the delivery spectrum. That integration, however, demands trust among the participants—and a rationale for sharing their information with other players. With its regulatory changes and focus on financial alignment, the ACA is providing that rationale, giving healthcare stakeholders incentives for collaborating to improve outcomes and limit costs.

Data Standards and Governance

To automate integration so data can become an actionable part of the healthcare planning and delivery processes requires addressing two key areas—data standards and data governance:

  • The slow pace of developing interoperability standards remains a hurdle to the seamless integration and exchange of data. Moving forward demands the faster and broader adoption of specifications and systems that can handle extracting, translating and loading large data sets from a variety of sources into a normalized data repository.
  • Accessing and integrating data effectively require a full understanding of the laws and practices governing its use. Organizations that know the rules and have robust privacy and security policies will be better prepared to manage the flood of information from all of their partners.

The Shift from Volume to Value

As health reform moves forward, we are seeing a shift in the focus of our regulatory, delivery and payment systems from volume to value. This new perspective will mean changes for both providers and product suppliers, including the need to:

  • Become successful risk-bearing organizations.
  • Demonstrate the real value of their products, in lowering costs and improving outcomes for complex patients, as well as in increasing the chances of keeping less-acute patients healthy and out of expensive treatment settings.
  • Support a value-based purchasing strategy.

Organizations that effectively navigate these changes will allow more of their products to be integrated into the benefits packages provided on exchanges.