Data is everywhere in health care – the results of a lab test, immunization records and cholesterol levels are considered data. What if some of that same data could be used not just to treat but to predict future health conditions like diabetes?
It’s already happening. Data in the hands of providers and their staffs in value-based care settings is having an impact on health care in Nebraska.
“We’re empowering our partners in value-based care with claims data, so they know more about their patient’s health,” Dave Wirka, Blue Cross and Blue Shield of Nebraska Director of Network Innovations said. “They can see how patients with chronic illnesses are handling their disease, and whether or not they are taking the prescribed drugs and following treatments.”
The data along with incenting health care providers for the quality of care they give their patients is providing better care and lowering costs. That’s value-based care. It’s defined by centering care around the patient. Creating points of contact beyond the exam room to keep the patient healthy and out of the ER or hospital. It’s a shift from “fee-for-service” models which pay providers for each service or procedure.
The results from Think Whole Person Healthcare a primary care (BCBSNE owns Think) clinic in Omaha, show how using data and coordinating care resulted in an average savings of $1,300 per patient in 2017. Nebraska Health Network, another value-based care organization, reduced outpatient procedures by 4 percent and hospital admissions by 2.7 percent last year.
“Success is bending the cost curve,” Wirka said. “Now we must continue to drive innovation and adapt to the changes in the marketplace.”
Blue Cross and Blue Shield of Nebraska has more than 300,000 or 38 percent of its members in value-based care. Creating even more opportunities for independent providers and developing virtual clinics to improve access to value-based care are the next steps in the evolution of the concept.
“If you incent a provider to recommend the most cost-effective specialist or treatment the cost of care will go down,” Wirka said. “Then it won’t be based on a relationship the provider has with a specialist but on the data.”
That leads to better decisions and a better quality of care for patients enrolled in value-based care.