The Power of Data: How Health Information Professionals are Shaping Healthcare's Future

In January 2023, The Commonwealth Fund highlighted a troubling reality: while the US healthcare system spends more per citizen on healthcare than any other nation, it delivers subpar patient health outcomes. This discrepancy can be attributed to outdated administrative and reimbursement support systems, which have not kept pace with advancements in medicine and technology. In response, the concept of value-based care has emerged, aiming to prioritize wellness over disease treatment, incentivize quality outcomes, and replace traditional fee-for-service models with at-risk, value-based contracts.

The Journey to Value-Based Care

The shift away from fee-for-service models towards value-based care has been an ongoing process for nearly five decades. Several innovative payment models, such as the Pioneer and Next Generation Accountable Care Organization (ACO) models, Bundled Payments for Care Improvement Initiative, and direct contracting, have emerged to steer the transformation. These advancements have opened new avenues for health information professionals, presenting opportunities for career growth and improved healthcare experiences for patients.

CMS' Ambitious Goals for Value-Based Care

The Centers for Medicare and Medicaid Services (CMS) have set forth ambitious goals to ensure that by 2030, all traditional Medicare and a vast majority of Medicaid beneficiaries will be treated under a value-based care model. Although these goals may seem challenging, they are achievable with strategic guidance and support from Health Information professionals.

Three Key Factors Shaping the Future of Value-Based Care

1. Red Tape! Healthcare regulations heavily influence the adoption of value-based care. As provider organizations adapt to new reimbursement models, Health Information professionals play a crucial role in reengineering workflows, policy development, and ensuring compliance with regulatory guidelines. By taking leadership roles and advocating for effective health IT use, Health Information professionals can optimize their expertise and drive the successful implementation of value-based care.
2. Data and Information! (a FAVORITE!) Data is the foundation of reimbursement in value-based care. Health Information professionals excel in establishing standardized processes for capturing and reporting data, ensuring the success of new care models. They also play a key role in maintaining data integrity and security, using coding and clinical documentation skills to ensure the accuracy of patient information.
3. Interoperability and Technology! Seamless data exchange and interoperability are essential for successful value-based care. Health Information professionals collaborate with IT colleagues to assess healthcare organizations' technology needs and align them with value-based care objectives. By bridging the gap between IT and clinicians, Health Information professionals ensure effective use of technology to meet value-based care requirements.

Securing a Space in Healthcare

To maximize career growth opportunities in value-based care, Health Information professionals must take proactive steps:

• Get Involved! Express interest in participating in value-based care initiatives and actively engage in relevant forums to contribute expertise.
• Educate! Advocate for the value of HI skills in data integrity, compliance, and outcomes measurement to gain recognition and support from leadership and stakeholders.
• Grow your Expertise! Invest in continuous professional development to stay abreast of industry trends, regulations, and technologies.
• Think BIG! Embrace innovation and explore new roles that leverage unique skills to pioneer initiatives driving the future of healthcare.

The journey towards value-based care is transformative, and health information professionals have a crucial role to play. By securing their space in healthcare, Health Information professionals can help shape the future of healthcare, improve patient outcomes, and drive the success of value-based care initiatives for years to come. Their expertise in regulatory compliance, data usability, and health IT will be essential in achieving CMS' ambitious goals and optimizing the potential of value-based care.

by Nicholas Wyatt, RHIA, LSSGB, CRCR

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