While interoperability and price transparency rules are supporting a movement toward better access to data, the industry is still struggling to transition from sharing information to shared decision-making. Unfortunately, without accurate information embedded in their workflows, providers can’t have meaningful conversations with patients about care costs or covered options, which negatively impacts a patient’s ability to access care.
Although electronic health records (EHRs) are nearly ubiquitous, the data within can be inaccurate, out-of-date, or missing altogether. This prevents patients – who are becoming more active healthcare consumers – from trusting their providers when discussing care options and costs. It is possible to find lower-cost care options and avoid unnecessary administrative burden, but not without better data.
Moving from information sharing to shared decision-making
While much of healthcare has been digitized across the last 30 years, the patient experience has fallen short of expectations. Patients still suffer from a fragmented experience where cost is disconnected from care and it takes time to understand options. The good news is that conditions are right for lasting change, and as an industry, healthcare needs to take advantage.
Four key dynamics are at play to create this opportunity:
- Most experts agree that we have achieved the goals of meaningful use and medical records are digitized.
- Patient out-of-pocket costs continue to rise, driving consumer demand for more information – particularly cost information.
- The pandemic has made us more comfortable managing healthcare electronically.
- There are significant legislative tailwinds, primarily driven by the 21st Century Cures Act and rules around information blocking.
In order to facilitate informed decision-making between patients and providers, we must allow access to real-time, personalized data. Micky Tripathy, the National Coordinator for Health Information Technology, outlined his priorities in a recent editorial. He focused on the continued enforcement of information blocking regulations, standardization of APIs for health IT certification, and implementation of the Trusted Exchange Framework and Common Agreement to create an infrastructure backbone that will ease information sharing across all health IT systems.
Getting the right information into the hands of patients and providers is widely supported, and we have seen significant progress in data availability across the last decade.
Data quality must be a priority
Simply delivering data cannot be the end-goal, however, since technology vendors also have a responsibility to maintain and improve the data flowing through their pipes. Vendors must enable intelligent filters and normalization tactics to reduce noise and drive meaningful action.
For instance, new methods of translating provider input quantities to billing quantities is enabling more pricing options to show within the EHR. Previously, if input units were not recognized by the payer, no pricing would be displayed. A common example of this occurs when a provider orders insulin in familiar ”clinical” terms (4,500 units of an injectable). Using these units, the price displayed may be more than $100,000, since the clinical units are often 100 to 300 times the billing units needed for pricing. Translation: both clinical logic and filters are essential to create a seamless and actionable provider-patient interaction where shared decision-making can take place.
An Arrive Health survey found that 77% of providers had to change, manage, or resend a prescription order once it had been sent to the pharmacy, while 78% of providers who had access to coverage information did not find the information reliable. Inaccurate and obsolete data are unnecessary in EHRs and cause frustration throughout the healthcare ecosystem. “Access to a patient’s unique coverage details could better inform provider decision-making, reduce patient affordability worries, and lower care adherence concerns,” the survey found.
The healthcare industry has been working in silos for decades and the burden of finding lower-cost options – searching for care locations, discounts, or covered services – is often on the patient. Now is the time to create a robust network that can deliver accurate cost and coverage information to care workflows. This will enable patients not only to understand the cost of their care, but to discuss covered options and lower-cost alternatives with their provider. Further, with accurate data at their fingertips, providers can reduce unnecessary administrative burden and improve patient outcomes.
We are in a historic moment in healthcare. The technology available to us is finally capable of the level of data exchange needed to dramatically improve access to care. Now is the time for stakeholders across the value chain — EHRs, providers, health plans, pharmacy benefit managers, as well as innovators and disruptors — to come together to expand the available data and extend its impact. Only by working together can we make a long-lasting impact for patients nationwide.
To learn more about how Arrive Health is delivering valuable data and insights to providers, care teams, and patients, visit ArriveHealth.com.