A letter from the guest editor highlights the significant work that remains for provider organizations to integrate digital advancement as a key strategy in addressing some of the most pressing challenges that are transforming the health care landscape.
Am J Manag Care. 2022;28(1):9-10
When The American Journal of Managed Care® published its first Health Information Technology special issue in 2012, the health care industry was on the precipice of widespread digitization. The subsequent decade brought dramatic increases in electronic health record (EHR) adoption and attestation to the use of defined documentation practices and functionalities that are key to realizing the value of technology-enabled health care. Focused policy-driven efforts, combined with market forces, have resulted in great progress. And yet, despite the many challenges encountered and described by researchers and practitioners along the way, we’ve come to realize that digitization was the easy part. True digital transformation—the reimagining of health care to seamlessly leverage technology in pursuit of safer, more accessible, higher-value care—remains aspirational. Significant work remains for provider organizations to integrate digital advancement as a key strategy in addressing some of the most pressing challenges that are transforming the health care landscape. These include prioritizing performance under value-based contracting, committing to a new understanding of whole-person patient care, and finding an organizationally sustainable approach to virtual patient engagement.
Performance Under Value-Based Contracting
Accountable care organizations (ACOs) and other value-based payment redesigns rely on data infrastructure that supports more effective care coordination and advanced analytics to address unsustainable cost and quality concerns. Apathy et al demonstrate in their work that hospitals do indeed broaden their health information exchange efforts after joining an ACO, but response lags and is a smaller effect in markets where ACO penetration is low. This finding underscores the interdependent nature of organizational investments in data sharing and points to the necessity of continued policy efforts to more directly incentivize, support, and regulate interoperability in the context of value-based payment arrangements. Survey work by Perloff et al describes a different but related ACO challenge emerging from continued data silos. Their work demonstrates, on average, a high number of different EHR developer products in concurrent use within a given ACO and the distinct challenges with integrating, managing, and analyzing these data to generate performance data. These issues, if not addressed, impede the advanced performance tracking necessary for organizational learning and improvement.
Committing to a New Understanding of Whole-Person Patient Care
The information that providers use to make patient care decisions, and that informs more structural investment in population health, is evolving rapidly. Organizations need the capacity to identify and act upon patients’ social needs and risk factors, such as food or housing insecurity, that critically shape their well-being and interactions with the health care system. Given the challenges of collecting these data, Vest et al convened an expert panel to identify and assess the quality of routinely collected structured data that could be used to impute and characterize social risk. The authors highlight data elements that may be most useful in the current data environment, and they also outline plans for the continued development of methods and approaches that mitigate the current limitations and bias with which these data are often recorded. Walker et al also focus on addressing social risk, analyzing a regional effort to promote health system patient referrals to community-based services for food insecurity. Findings illustrate the challenges of implementing the data sharing that is necessary to support cross-sector partnership. The authors offer key insights into how we might address the technical capability and resource limitations, as well as characteristics of the regulatory environment, that impede these critical efforts.
As we consider advancements in data-driven health care decision-making, use of predictive analytics is also top of mind for health systems. The exponential acceleration in the volume and types of data available for advanced analytics, and sophisticated methods for doing so, far outpaces our knowledge of how to integrate predictive insights into provider decision-making. Nong et al use user-centered design to determine what information providers need to assess these tools and integrate them into care decisions. Given mounting concerns about care delivery biases that are reflected and amplified in the design and use of these tools, the authors highlight key ways that equity considerations should be incorporated into model development and into the communication of predictive tool results to end-user clinicians.
Finding an Organizationally Sustainable Approach to Virtual Patient Engagement
The ongoing COVID-19 pandemic disrupted and accelerated health system planning around virtual care offerings. Data suggest that telehealth services have plateaued at levels that are down substantially from spring 2020 but still much higher than prepandemic volumes. As a result, provider organizations continue to grapple with how to implement and sustain more strategically hybrid models of care delivery. This includes, first, offering telehealth visits. Friedman et al suggest in their work that telehealth shows significant promise for reaching patients with mental health and chronic condition management needs, including in older and more racially diverse neighborhoods. Work presented by Tan-McGrory et al offers strategic recommendations for advancing virtual care services with equity in mind, including improving technology access, addressing immigrant patient concerns around privacy, and enhancing integration of interpreter services.
Organizational efforts also must consider how best to incorporate and support use of online communication tools to increase patient engagement and access to providers. Work by Fareed et al suggests that patients who use patient portals have higher satisfaction scores. However, Escribe et al offer insight into the organizational challenges of managing the communication that flows into a practice via these online access points. The authors use a novel detection approach to categorize the types of tasks that providers manage through their email inbox and find high variation of clinical but also administrative requests. These methods may have future application for helping provider organizations develop clear expectations and team-based workflows for how virtual communication should be used to best support the full spectrum of patient needs.
Digital advancement is not the end goal but instead a strategic approach to organizational learning, care process optimization, and data-driven outcomes improvement. The areas of research focus in this special issue, and specific insights offered by authors’ analyses, help us chart a path forward to integrating and realizing value from our continued commitment to digitally enabled health care.