We all agree, health care can be complicated.
Especially when you move between doctors and health care systems. They need to talk with each other to share your basic health care information. This is called interoperability, when different information systems, devices or applications connect or coordinate to optimize health care.
The National Academy of Medicine says despite 96 percent of hospitals and 78 percent of physicians’ offices using electronic health records (EHRs) – information from multiple sources still is unable to flow at the right time to the right person.
The example the study uses – fewer than one in three hospitals can electronically find, send, receive and integrate patient information from another provider.
The situation can get tangled too when insurance companies try to pay providers who administer value-based care. There’s little interoperability to reimburse providers for the quality of the care they provide to their patients instead of using the number of patients they see as a measure.
Cutting through the ‘noise’
Enter a team from Blue Cross and Blue Shield of Nebraska. They have found a way to ‘cut through the noise’ in the billing process between Blue Cross and Blue Shield plan nationwide and help create an easier way to pay providers for their value-based work.
“We’re laying the groundwork for change,” Howard Jones, Lead Enterprise Product Owner said. “Easier reporting leads to more sharing and transparency which helps providers and their patients.”
Providers don’t see the processes the team developed, but they feel the outcomes in quicker reimbursement and fewer billing disputes.
Dave Wirka, director of network innovation at Blue Cross and Blue Shield of Nebraska says new IT infrastructure is critical for the advancement of reimbursement models that improve health care quality and efficiency.
“Howard’s team created an innovative application that allows our members access to more than 59,000 value-based primary care providers nationwide,” Wirka said.
Value-based care growing
Value-based care as an alternative to the old fee for service system is continuing to grow and mature. According to the Health Care Transformation Task Force (HCTTF) in 2017, 47 percent of its members’ business was some sort of value-based care. In Nebraska, Blue Cross’ value-based care partners have reduced health care costs and achieved $27 million in shared savings in 2018.
Paying for quality care is the industry’s most promising strategy for controlling health care costs and improving outcomes. Helping improve the billing process is another step in that direction.