CIOs Share Their Challenges and Strategies in the Shift from Fee-for-Service to Value-Based Care

CIOs Share Their Challenges and Strategies in the Shift from Fee-for-Service to Value-Based CareIn a recent online focus group conducted with College of Healthcare Information Management (CHIME) CIO members, Pivot Point Consulting gleaned front-line feedback on healthcare organizations’ progress in the segue from fee-for-service (FFS) to value-based care (VBC). CIOs from across the continuum of care—including health system, health information exchange, medical group, and post-acute care settings—offered candid insight into the strategies they have employed and some of the challenges encountered in the transition. Here is a glimpse into what these healthcare executives had to say.

On the road from FFS to VBC, what keeps you up at night?

 “The things that keep me awake at night are definitely the employees. We put a lot of strain on our employees because we’re always trying to do more with less. Good talent is so hard to find and the constant pressure is on them. That’s really what I worry about. How can we take care of them better so they’re not worn down and they stay with us?”

– Curt Kwak, CIO, Proliance Surgeons

What analytics resources are you using or seeking to use? What processes have you put in place to make information that comes out of those analytics actionable?

“We’re the hub of medical transactions across the community. We can show a provider all the encounters their patients have outside their organization. For example, there were 46 other providers that have information on their patients. This may be quite a shock for those that think, ‘Our patients only come here. We have no patient leakage.’

“ACOs and provider organizations with an MSSP or other financial risk arrangement can receive real-time alerts on those patients. With their member roster, we match them against ADT feeds from all our participants creating the alert.  Based on the integration we have with our participant EHRs, we not only share that clinical information but also notify on the timing of it. In other words, if an MSSP member presents to an ED, the alert will enable the opportunity to better manage the care delivered to their at-risk patients.”

– Nick Bonvino, CEO, Greater Houston Healthconnect

What are your thoughts around better cost management and more efficiency?

“We’re in the oncology space and we’re trying to be thoughtful and careful to create analytics capable of looking at the full cost of providing the treatments and the different service lines. It really is about inventorying all those costs and merging the clinical piece and the financial piece into a common model to look at cost from cradle to grave. That process we’ve been working on for about a year and it’s a daunting task.”

– Darin Mayer, CIO, e+CancerCare

“Having been a CIO of a specialty care organization, the other challenge with this area is, as patients come to you, a little-known rule we’ve discovered is that, if the patient has not seen or does not have a PCP, all of the costs that are associated to that year are now associated to that specialty provider. That’s one of the early challenges that we’re trying to figure out how best to address–that we ensure patients have actually seen their PCP before coming to see us. They can say they have, but how do we validate that?”

– Sean Moynihan, former CIO, Virginia Urology

What challenges and successes have you encountered in the migration from fee-for-service to value-based care? Contact us to talk more.