Effective EHR systems can power the shift to value-based care
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Despite its documented ability to improve health outcomes and reduce overall costs, the full-scale adoption of value-based care, including in kidney care, continues at a snail’s pace.
In many cases, the slow uptake is because physicians have found it difficult to make the changes necessary within their practice to take full advantage of value-based care (VBC) contracts and arrangements. The perceived “value” in VBC has not been great enough to overcome the anticipated disruptions and risk of transitioning away from traditional fee-for-service practice.
For nephrologists transitioning their practice into VBC, the right electronic health record can tip the scales and make the leap easier. A well-designed and implemented EHR is a powerful instrument for aligning incentives and driving practice changes that enable physicians to be successful in risk-bearing, pay-for-performance arrangements.
While implementing a new EHR can be complicated and time-consuming, there are tremendous benefits.
The right EHR will take a practice well beyond mandated data capture and reporting. It will enable and drive population health decisions, timely interventions, earlier identification of at-risk patients, help reduce readmissions and more. All of that adds up to better outcomes, lower costs and more opportunities for physicians.
Here is how an effective EHR can make a difference.
Access to complete information
One of the basic ways EHRs facilitate VBC is by making complete and accurate patient information more readily available. Timely and relevant access to patient data is a key requirement in providing quality care for patients with chronic kidney disease and end-stage kidney disease.
Personalized kidney disease care with individualized interventions requires the ability to manage clinical data sets across time and points of care. By better understanding a patient’s real-time clinical status and social needs, clinicians can provide a whole-person experience, including clinical, behavioral and environmental.
The goal must be a holistic view of the records that “follow the patient,” offering a comprehensive view of the patient’s journey as well as support for the nephrologist. We need access to patient data captured wherever and whenever they have been cared for — be it the nephrology clinic, the patient’s home, the dialysis unit or a hospital.
Equipping providers with full patient records at the point of care is essential for ensuring that nothing gets missed; when physicians and other providers have access to complete patient information, it improves patient safety — promoting one of the core elements of VBC.
A full-picture view of a patient’s history can also eliminate redundancies in care, preventing duplicative tests, treatments and other unnecessary costs. This makes care more efficient and more effective, supporting a key aim of VBC.
Time with patients
One of the main promises of VBC is the potential to allow more time with patients. We all spend too much time with data entry and recording patient notes. But if an EHR can remove some of this administrative burden, we can have more face-to-face time with patients — invaluable for any physician. An Epic-enabled system will also allow us to take advantage of the evolution in new artificial intelligence-enabled language processing tools to aid us in notetaking, making our time with patients even more valuable.
Additionally, EHRs that are intuitively designed can accelerate the care coordination and collaboration processes, which can save a lot of time for nephrologists. It can help providers and the team focus on those patients who are at risk for immediate adverse outcomes, allowing the care team to spend more time with those patients who need it most. By engaging the entire clinical team, providers are freed from some of the operational burdens of getting a patient from one point to the next.
Diagnose and manage
Improved patient safety and outcomes are another key element of VBC. By providing clinicians with better access to patient information, EHRs can improve the ability to diagnose and manage other chronic conditions, as well as to expose potential safety issues.
A VBC-enabling EHR gives providers a wide and deep view of a patient’s medical history that often is not available on systems less tuned to VBC. This allows providers to track patient health data over time, which can make it easier to monitor progress and identify potential gaps in care and safety concerns.
A comprehensive EHR also makes it easier to share treatment plans with patients, helping to engage them in managing their own care and increasing patient compliance with plans. This patient-centricity, enabled by the EHR, is a foundational pillar of VBC and a key to unlocking its full benefits.
Both of our practices participate in the new Comprehensive Kidney Care Choices government models, which strongly incentivize an optimal transition to ESKD. Our EHR has become an important tool to help identify key moments in the transition of care and provide insight into a patient’s CKD progression, while making reporting on key metrics easy to access. The result of shifting to a VBC-enabled EHR has been a steady improvement in optimal starts and better outcomes for our patients.
Preventative care
One of the major targets for VBC is an increased focus on prevention-based services, such as immunizations and diagnostic screenings.
VBC contracts often include payment and incentive structures rewarding proactive, preventative care. EHRs should enable this forward-thinking focus by providing timely reminders for screenings and preventative care delivery.
When the entire care team is prompted to be more preventative-focused, it can lead to a practice-wide shift in thinking. Engaging the entire care team, including the front desk, care coordinators, nurses and physicians, is essential in moving the needle on the quality metrics required by VBC contracting.
By facilitating prevention-based services, EHRs can help decrease the overall cost of care by reducing future medical services such as ER, hospitalization, lab testing or imaging — supporting another central tenet of VBC: efficiency.
Communication outside the practice
Effective, efficient VBC is highly coordinated and collaborative. When patient information is housed in discrete siloes across many providers and systems, nephrologists are challenged with “connecting the dots” to coordinate safe, quality cost-effective care.
In nephrology, as patients transition from late-stage CKD to ESKD, care coordination among the entire care team is vital to achieving optimal patient outcomes. And yet, some EHRs do not offer the basics of coordinated care such as a common and easily accessible location for care coordination charting. A good system must empower care coordination, not impede it, by capturing critical data points for an individual patient in one easily accessible location.
Nephrologists often serve as principal care providers for many patients with ESKD. The practices must have access to information gathered from outside their office. These details cannot simply be available at the patient’s next appointment. A powerful EHR will proactively alert the provider so action can be taken immediately, if necessary.
Population health
Using multiple data sources, a powerful VBC-tuned EHR can discern and identify population trends and risk factors that empower providers to take proactive action to head off more serious health issues, improving quality of life and controlling spend.
For instance, a comprehensive platform might identify a population that is driving up costs because there are few health care options nearby other than an ED. For nephrology practices participating in VBC arrangements with private and government payers, the EHR also provides the ability to measure, document and report the effects of VBC efforts across the entire population. This function can significantly impact incentives and other payments for the practice.
Our practices are seeing the benefits of embracing value-based care, and the right EHR can make this switch easier and more effective. We are living in two worlds right now with one foot in fee-for-service and the other in VBC. Technology that helps us navigate both worlds is critical to our success. An EHR cannot simply be a data warehouse. We are seeing how the right EHR is helping fulfill the promise of VBC by improving patient care and lowering total costs.
- For more information:
- Anthony Brown, DO, MS, FASN, is a nephrologist with Nephrology & Hypertension Associates of New Jersey. He can be reached at doctonybrown@comcast.net.
- Carney Taylor, MD, MBA, is co-president of Eastern Nephrology Associates in Greenville, North Carolina. He can be reached at ctaylor@easternnephrology.com.
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