How Investments in Interoperability Accelerate Value-Based Care

Byline: Dr. Alex Ding, Deputy Chief Medical Officer

As a practicing radiologist, I still see patients carry their medical imaging on a CD between doctor’s appointments. There is a better way. 

Patients need simple, universally transferable, secure medical records and data that are shareable amongst everyone taking care of them. Not only is this interoperability better for the patient and member experience, but seamless information sharing and real-time data is critical for better patient health outcomes and less administrative time for clinicians. 

Interoperability provides a holistic understanding of patients’ needs. 

Interoperability is the secure exchange of health data creating ease for patients and clinicians. For example, interoperability allows a primary care clinician to see a patient’s most recent hospitalization or prescription fills in a pharmacy. Then, clinicians are equipped for timely follow-up after a referral or hospitalization and for management of chronic conditions with simpler view into medication adherence. 

When clinicians have actionable data and efficient population health management workflows, they are equipped with a whole person view in every patient interaction. Value-based care models (VBC) must be implemented hand in hand with seamless information sharing to deliver better health outcomes.

A value-based model of care prioritizes disease prevention, management of chronic conditions, and whole-person health. Providers under value-based care payment models are incentivized not for how many patients they see or procedures they perform, but for the impact on health outcomes. Providers operating under fee-for-service remain in a reactive mode to patients’ long-term needs. 

For practices looking to be successful in value-based care, interoperability is a key ingredient for early investment. 

Integrated technology and real-time population health data empowers clinicians under VBC models to practice proactive care management and impact patient health outcomes. More than a decade of Humana’s research on value-based care paints a clear picture. 

• VBC Medicare Advantage patients saw 32.1% fewer inpatient admissions in 2023 versus those enrolled in Original Medicare. 
  
• Humana Medicare Advantage members receive more preventive screenings than those under non-value-based providers across these measures: annual wellness exam, colorectal screening, diabetes eye exam, and mammogram.

With investments in interoperability, value-based care practices have a foundation for success. 

Actionable data is at clinicians’ fingertips to identify population trends, identify care gaps, and proactively reach out to patients for medication adherence or after an acute episode. 

"Having a comprehensive view of our patients' medical history and health insights allows our clinicians to dedicate more time to addressing health concerns and setting a course for treatment," said Philip Oravetz, MD, chief population health officer, Ochsner Health. 

Clinicians in value-based care practices are enabled to spend less time on administration, more time with patients, and more easily practice with a whole-person health point of view. Quality data in value-based care creates a positive experience for clinicians and better health outcomes patients.

Humana is a leader in advancing interoperability and value-based care. 

Epic recognized Humana’s interoperability efforts with its new Blue Ribbon certification, the only payor to receive this distinction, which required our technology to meet rigorous standards. Thus far, we have connected over 650,000 providers and securely share more than 200 million clinical records across 6 million members. 

Humana’s Population Insights Compass is a robust tool that predicts health-related social needs data and identifies opportunities around care gap closures, patients who have not had a PCP visit in 12+ months, and patients who were recently discharged and need a PCP follow-up.

Interoperability is a critical piece of success in value-based care. 

Value-based care is the right path forward for patients and clinicians. Interoperability is a key piece of the foundation for success in VBC. I encourage every clinician to recall their most recent patient interaction. Imagine the difference in administrative time and patients’ preventive health when seamless data allows for action. Join Humana in advancing value-based care models and accelerate interoperability.

Learn more about Humana’s approach to value-based care in the 2024 Value-Based Care (VBC) report.