As many healthcare industry insiders know, there is exciting energy coalescing around payment transformation, away from paying for volume of healthcare services (AKA “fee-for-service”) and towards incentivizing better health outcomes (AKA “value-based”). These payment innovations are happening in multiple sectors of the industry, perhaps most notably and impactfully 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. While this is likely good news from a long-term perspective, it is generating tremendous short-term turbulence in care delivery, where the changes in the incentive structures have yielded new rules and capability needs - for documentation, data collection, collaboration, etc - and have created a seismic disruption in workflow.
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 APMs requires new tools - tools which, until only recently, have not ever existed in the healthcare industry. This has created frustration among primary care physicians (PCPs) who were already straining against monumental administrative burden and associated existential stress. Without the right tools integrated into the clinical workflow, PCPs have struggled to find a way to be successful in APMs, and this has stymied adoption of these new payment options even though they potentially hold the promise of better resourcing for primary care systems, higher income for primary care providers, and better outcomes for patients.
Legacy electronic health records (EHRs) which primary care practices and others 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 yet enduring them as inescapable 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 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 that centers their individual needs. Elations’ “clinical-first” approach, combined with a deliberately intuitive design and a deep commitment to product development around the unique needs of 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.
Elation’s unique approach to support primary care success in APMs has been to create an open architecture which invites seamless integration of a “best-in-breed” collection of solutions, all driven through the fundamental EHR workflow where primary care teams spend their time. The strategy is to design a product that offers a core set of native capabilities focused on the unique needs of high-value primary care, and let the user customize a digital ecosystem tailored to the particular needs of their care delivery program(s) without creating fragmentation or duplication of workflows.
Consider an example based on a real Elation customer experience: a physician organization supporting over 800 independent physicians in the shift 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 vendor in an effort to address these challenges, but this was not effective in engaging providers because it was segregated from their EHR and lack of data integrity was causing inaccurate reporting.
Their story is not unlike other entities that are looking to translate population health and value-based contract data into actionable 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:
An increase in chronic condition assessment rate of 21% within 6 months, as compared to the previous calendar year
An improvement in post-hospitalization transitional care management services of 300%.
An increase in coding compliance for body mass assessments (already being performed and documented in the encounter note) from 32% to 98%.
An increase in coding compliance for blood pressure screenings in hypertensive and diabetic patients from 18% to 97%.
96% of PCPs performing better or earned more incentives on Elation’s solution than previous year’s performance on a separate solution
Payment transformation in healthcare is here to stay, with primary care 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 enable that success.
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.