Value-Based Care Model: Elation EHR ranked #1 tool
Original post: April 7, 2023, Updated July 30, 2024
There's an exciting energy around payment transformation in the healthcare delivery system, including the role of accountable care organizations (ACOs) in this shift.
What are ACOs?
ACOs are networks of healthcare providers who provide coordinated, high-quality care to Medicare beneficiaries while reducing healthcare costs.
These payment innovations are happening in multiple sectors of the industry, perhaps most notably—and with biggest impact—in primary care where private investors, government programs, commercial insurers, and self-funded employers are all experimenting with alternative payment models (APMs).
The goal of these efforts is to reign in wildly out-of-control spending and get better value for the healthcare dollars spent.
This is likely good news from a long-term perspective. In the short-term, however, there is tremendous turbulence in care delivery: changes to incentive structures yield new rules and capability needs—for documentation, data collection, collaboration.
Payment transformation in value-based care is creating a seismic disruption in workflow.
What is a value-based care model?
Value-based care describes health care that is focused on patient experience. In value-based care, "value" refers to measuring health outcomes to show improvements in patient health outcomes based on the costs associated with that improvement.
Some descriptions confuse value-based services with cost reduction or patient satisfaction. Although important, the true value relates to improvements in patients' health (which makes patients happy, and tends to cost less than traditional models (like fee for service).
The American Medical Association describes high-quality health care in six dimensions:
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secure
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timely
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effective
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efficient
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equitable
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patient-centered—STEEEP
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There are four pillars to value-based care:
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Governance: based upon health care provider knowledge, engagement, and energy
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Transform data for clinical financial or operational problems
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Transform analytics: use information to identify individuals.
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Transform payment system: Use a sustainable payment system
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Each of these serve the same purpose: run healthcare in America in a more efficient and effective way (based on patient value).
The problem is the barriers to value-based care; namely, payment transformation.
"Payment transformation in value-based care is creating a seismic disruption in workflow."
Defining and Implementing Value-Based Health Care: A Strategic Framework for better patient health outcomes
Supporting value-based care through payment transformation
One thing we know about payment transformation is that the health technology industry has some catching up to do.
Performing (and reporting) the activities necessary to be clinically and financially successful in these alternative payment models requires new tools—tools which, until only recently, have not existed in the healthcare industry. This has created frustration among primary care physicians (PCPs) and health care providers already straining against monumental administrative burden.
The health care system needs to adapt to these changes to support value-based care effectively. Coordinated care is crucial in these value-based care models, ensuring that patient care is well-managed and efficient.
Without the right tools in the clinical workflow, PCPs struggle to succeed with APMs, and this has stymied adoption of these new payment options even though they hold the promise of
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better resourcing for primary care systems
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higher income for primary care providers
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better health outcomes for patients
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Effective care coordination leads to better patient outcomes and lower healthcare costs.
"It is rare to find a physician who says anything more positive about their EHR than, 'It’s not the worst one I’ve used.'”
Legacy EHRs: outdated and frustrating to use
Legacy electronic health records (EHRs) which primary care practices have been using — in some cases for decades — have primarily been built to support success in the fee-for-service payment model. Clinicians struggle daily with these EHRs, complaining bitterly about them while trying to make the best of it.
In a 2016 report, physicians surveyed about their experiences using ambulatory EHRs revealed abysmally low net promoter scores, ranging from 5% to negative 73%. It is rare to find a physician who says anything more positive about their EHR than, “it’s not the worst one I’ve used.”
Elation EHR: The most highly-rated EHR in the U.S. today.
Elation Health is the exception.
The company’s founders set out to modernize the EHR experience for primary care clinicians with a lofty goal of creating a physician experience that fosters trust and promotes relationships with patients by putting their needs in the center.
Elations’ “clinical-first” approach, combined with a deliberately intuitive design and a deep commitment to product development that serves primary care, has made Elation Health the most highly rated EHR in the U.S. today, according to studies conducted by the independent research firm KLAS
Co-founders
Elation’s unique approach to support primary care success in APMs is to create an open architecture to plug in a “best-in-breed” collection of solutions, all driven by the EHR workflow where primary care teams spend their time.
The product design starts with a core set of native capabilities focused on the unique needs of high-value primary care. From there, flexibility lets user customize a digital ecosystem tailored to the particular needs of their care delivery program(s) without creating fragmentation or duplication of workflows.
Real world Elation customer experience
A physician organization supporting over 800 independent physicians shifted to value-based arrangements. In this case study, new quality program requirements increased physician administrative burden and added risk to the practice revenue and overall practice viability. The organization deployed a population health management vendor to address these challenges, but failed to engage providers because it was segregated from their EHR. Lack of data integrity caused inaccurate reporting.
Their story echoes other health care teams that are looking to translate population health and value-based contract data into insights for the physician and their care team.
To address this, Elation seamlessly embedded value-based contract requirements within the natural clinical workflow and assisted with coding based on documentation already being captured in the encounter notes. This reduced cognitive and administrative burden for the physicians and drove remarkable success in value-based programs for customers:
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21% increase in chronic condition assessment within 6 months, as compared to the previous calendar year
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300% improvement in post-hospitalization transitional care management services
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66% increase in coding compliance for body mass assessments (already being performed and documented in the encounter note) from 32% to 98%
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79% increase in coding compliance for blood pressure screenings in hypertensive and diabetic patients from 18% to 97%.
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96% of PCPs performing better or earned more incentives on Elation’s solution than previous year’s performance on a separate solution
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Value-based care is still new for many health care providers, and many are still trying to implement the appropriate systems into their workflow
Payment transformation is here to stay
Combined payments involve certain risks.
Generally speaking, unless the service is reduced by the price of a bundle, the provider may pocket these costs. Nevertheless, when cost increases, the provider may lose money. The bundled payment arrangement also enables hospitals to significantly reduce costs and provide broader patient service.
Payment transformation in healthcare isn't going anywhere. Primary care is at the center of the solution driving wellness, improving health outcomes, and saving money for both consumers and payers. Only primary care can translate these new payment models into success, but they need the right tools to do the right work.
Elation Health is a key technology partner to support that success in the health system.
FAQs
How is value-based care different from fee-for-service models?
In traditional models (like fee-for-service reimbursement), health services are paid based on the number of services provided. The cost is a combo of commercial payment in private markets and a percentage of Medicare's total cost for similar services. Those fees are unbundled, so the service is billed separately.
What is an accountable care organization?
An accountable care organization (ACO) provides coordinating, individualized patient care. CMS created the program to assist the provider in the delivery of high quality care. ACO aims to prevent redundant and unnecessarily costly procedures while reducing the incidence of medical errors. Providers volunteer for ACO programs including Medicare Shared Savings programs, advance payment models, and Pioneer ACO Models. A network of providers shares savings when a provider delivers high-quality healthcare and reduces healthcare costs.
Sara J. Pastoor, MD, MHA is Elation’s Director of Primary Care Advancement and leader in primary care advocacy. Dr. Pastoor is a board certified and clinically active family medicine physician. Her experience as a primary care innovator spans a career in military medicine, academic medicine, private practice, and employer-sponsored delivery models. She received her MD from Rosalind Franklin University of Health Sciences and MHA from Trinity University.
