By Brett Furst

The story of value-based care so far has featured more talk than action, but that could soon change.

Most healthcare organizations are proceeding cautiously toward the value-based future, with many value-based reimbursement (VBR) programs still in the pilot stage, focused on one specific target: an episode of care, a certain cohort of patients, or one medical condition.

For example, a survey of 89 large physician practices late last year found that just 54 percent were participating in risk-based payment models at all, according to Sage Growth Partners. More tellingly, just 5 to 10 percent of revenues, on average, are tied to risk-based models among participating organizations, which illustrates the high levels of caution with which most in the healthcare community are approaching VBR.

Certainly, a number of these early forays into VBR have revealed its potential to lower healthcare costs while maintaining quality by delivering on the key promise of VBR: the alignment of all key care delivery participants’ financial incentives around similar cost and quality objectives. However, too many of these pilots simply aren’t broadly scalable across disparate healthcare organizations because they’re essentially held together by brute force – manual processes and cobbled-together technologies.

For value-based care to reach the “tipping point” that many expect in 2020, healthcare organizations will need to improve their ability to scale up VBR programs to include more patients and providers.

Before looking forward to the value-based future, however, healthcare organizations would be wise to look back at the recent past for other health information technology initiatives – such as health information exchanges, patient registries and regional extension centers – that present the following key lessons on how to successfully scale VBR programs.

Prioritize interoperability to facilitate data-sharing: A health information exchange (HIE) can be thought of as a network of networks, generally created by providers, to enable data-sharing across a number of different organizations, often those in geographic proximity. HIEs make it easier for providers to exchange protected health information to improve care delivery and point-of-care decision-making.

One essential function of HIEs is to address the well-documented problem of health information technology interoperability. Many healthcare organizations use different technologies with different capabilities that require data mapping and manipulation to achieve a consistent back-and-forth flow of information. HIEs solve this problem by enabling information to be shared more easily.

Successful value-based contracting requires a similar approach, in that payers and providers must share vast amounts of data during the negotiation process to properly evaluate different VBR options. To address the unease associated with this level of sharing, payers and providers need a neutral third-party partner who can assist them with the design, measurement and collaboration of VBR contracts. Blockchain holds potential to address this problem in the future but is still a long way off from widespread adoption.

Measure quality by standardizing information: Collections of standardized information on groups of patients who share key characteristics – patient registries – help providers obtain a greater level of granularity in examining and evaluating different procedures, episodes and conditions. Healthcare organizations aggregate this information to mine the data for insights into what works best, pointing the way toward opportunities to boost quality or lower costs.

Similarly, one of the most fundamental concepts of VBR is to incentivize changes in behavior to adopt best practices discovered by aggregating and analyzing patient data. One way of measuring success in VBR is through provider adoption of best practices, such as appropriate medication usage for patients with a certain condition.

This data aggregation, analysis, and quality assessment is also used to monitor and fine-tune the VBR contractual agreement, enabling participating payers and providers to continuously shape their networks and standards of care to optimize patient outcomes.

Overcome trust barriers to work together: To help providers navigate the adoption process of electronic health records, the federal government about a decade ago created regional extension centers. Their purpose was to assist primary care providers in a shared geographic area, helping these often competing medical practices to move toward the goal of higher-quality care through better technologies and processes.

Scalable VBR agreements between payers and providers are similar in that they depend on these traditional rivals collaborating to create a rising tide that lifts all competing boats. But getting there often isn’t easy, as doing so frequently requires payers and providers to overcome trust barriers that have historically frayed their relationships.

Often, a third party is needed act as the intermediary between payers and providers, delivering efficiency, predictability and consistency in VBR programs while creating an ecosystem that aligns payers’ and providers’ financial goals with patient outcomes. While trust does not require full transparency among rivals, it does necessitate that payers and providers develop enough confidence in each other’s intentions to make technology investments for their mutual benefit.

As VBR continues to become a more integral part of the health system, progress is likely to come in fits and starts – simply because there’s no blueprint, and many health organizations are still finding their way. But the good news is that we don’t need to start from scratch. Reflecting on key lessons learned about the importance of achieving interoperability, measuring quality, and working together around common objectives will help chart the course toward the value-based future.

About the author: Brett Furst serves as a strategic advisor to Payformance Solutions, where he leads go-to-market strategy and sales execution to realize Payformance Solutions’ vision of transforming payment transformation in the healthcare industry. He is a senior executive with over 27 years of experience in selling and managing technology solutions in the healthcare, manufacturing and CPG industries.