VOICES: Why Post-Acute Providers Are Tripling Down on Interoperability in 2021
This article is sponsored by MatrixCare. In this Voices interview, Home Health Care News sits down with ResMed Vice President of Strategic Initiatives Nick Knowlton to learn about the insights in MatrixCare’s newly released study on interoperability: “The Great Divide: research reveals continued interoperability gaps in post-acute care.”
The study reveals a number of insightful figures, including the soaring percentage of post-acute care providers that recognize the importance of interoperability to their referral sources, from 34% in 2019 to 95% in 2020. [Disclosure: Knowlton is also the board chairman of CommonWell Health Alliance.]
Home Health Care News: We last spoke in October, and so much has changed since then, including in home health. Interoperability has become even more vital. What actionable steps can agencies take to move their organization to a higher level of interoperability maturity?
Nick Knowlton: First and foremost, provider organizations need to be real about their current level of maturity. They need to objectively determine where they fit on the continuum because it is difficult to improve what we can’t measure or understand in the first place.
Second, I recommend that agencies engage their referral sources and their technology vendors. As we showed in the survey results, referral sources are very interested in Interoperability. Having a conversation with them about the future of your relationship, including their expectations and needs, is a great place to start.
As always, we recommend that provider organizations rely heavily on their EHR vendor and other technology vendors to understand how they can move up the scale of interoperability maturity. Lastly, we recommend that agencies adopt modern technology and network-based approaches that meet their needs. They should look at newer API technologies that include discrete data and national networks, such as CommonWell and Carequality, to help them move up.
What are the most important types of data that could be exchanged through interoperability that impact patient care?
Knowlton: Three of the top areas to explore would be Patient demographics, medications and visit notes and care plans. Patient demographics are important because they establish strong identity links between referral sources and post-acute care agencies. These links can be used for follow-up interfaces to create seamless communication between referral sources and other care providers.
Medications are another top request. Having a complete and accurate medication list prior to entering the patient’s home for the first time can make a huge difference in getting that patient’s care started the right way. From day one, providers can avoid the frustrating experience of sorting through shoe boxes full of medications to understand what the patient is or is not supposed to be taking.
For visit notes and care plans, the narrative of patients in post-acute is often very complex. Seeing what other providers say about recommended care pathways for patients based on prior encounters can augment the discrete clinical information that technology vendors like us at MatrixCare are capable of exchanging.
From 2019 to 2020, we saw a massive increase in the percentage of post-acute care providers that can receive patient demographic and clinical information. It went up from about 1/3 in 2019 to 3/4 and higher in 2020. Why has this happened and why does it matter?
Knowlton: Let’s start with why it has happened. I believe our industry as a whole has become much more educated about the importance of interoperability to their referral sources. As we saw in the survey data, there is a more educated post-acute care provider market with more opportunities to connect with referral sources as the demand for interoperability increases. There was a general pandemic uplift to the rising tide of interoperability as well: Jobs that were difficult without interoperability before the pandemic became almost impossible to do without interoperability during the pandemic.
There are a multitude of reasons why we saw this increase, but more important to focus on is the current level of interoperability. While the interfaces may not be fully-discrete data-capable yet — i.e., they may be mostly document-exchange-based for moving the demographic and clinical information at this point in time — it puts in place a basic level of interoperability. Providers on both sides will view that as a good place to get started. This gives post-acute care agencies and their referral sources a great launch pad to move into higher maturity levels of interoperability, which may include sharing signed documents and patient status updates, connecting with national networks to leverage existing health information exchanges and providing real-time notifications on shared patients.
Following up on that, where do you see interoperability heading over the next few years in post-acute care?
Knowlton: From 2019 to 2020, we saw a massive increase in post-acute care providers’ recognition of the importance of interoperability to their referral sources. This went from 34% of post-acute care agencies in 2019 up to 95% in 2020. This helps us see where interoperability is heading because it all begins with the provider attitudes towards interoperability. Now that they understand its importance, we see a willingness to get engaged with higher levels of interoperability maturity.
As a result, providers will have more access to discrete data and national networks than ever before and they will certainly have more involvement from patient and family members as the rise of consumerism within patient populations takes hold. Increasingly patients are demanding experiences more closely aligned with their other digital experiences, from online shopping to hailing a cab to checking their bank account balance. Patients today want to access their data, understand how their care is progressing, and be able to communicate in group settings.
This involves moving the data back and forth between different systems that patients and family members can access. We think the rise in recognition of the importance of interoperability will lead to a fast pace of change within our industry.
Due to the pandemic, the health care continuum is exploring alternate care delivery models. How do you see interoperability supporting those models as acuity increases in the home and the desire to receive care in the home also increases?
Knowlton: Value-based care is all about clinical information and other indicators of intervention. “Analytics” can be a very broad term, but it can refer to simple elements too, such as knowing that a patient who may have a high hemoglobin A1c and has not had a foot exam in five years needs interventional outreach.
All of those value-based care tools rely on knowing as much about a population at the individual patient level as possible. That is how we bend the health care ecosystem toward the goals of the triple aim: better outcomes, better patient experience and, of course, lower costs.
As demand for care-at-home models increases, the level of interaction with devices and care providers in the home also needs to increase. This gives rise to the greater need for interoperability.
With value-based care continuing to grow in importance, how does interoperability support that care? What does a post-acute care provider lose when it can’t stay on a higher level of interoperability?
Knowlton: When you are dealing with complex community workflows, analytics increasingly rely on interoperability. In higher acuity care-at-home models, the focus is on making sure the analytics engines have access to the best information possible. Analytics in and of itself is certainly susceptible to the computer science principle of “garbage in, garbage out,” meaning if you don’t have the right data in the system, you won’t get an accurate or useful response.
A provider that is not interoperable runs the risk of not providing as complete and timely care for patients as possible, opening itself to risk of disruption from competitors. Providers that lean into interoperability will have much greater probability of success for value-based care mechanisms moving into place today, and those that could emerge in the future.
The acute and ambulatory sectors are more heavily regulated from the ONC and CMS when it comes to interoperability and effectiveness. Why is post-acute left out of that, and what steps can operators take to make sure they remain part of the conversation? Could health systems take over the post-acute space and take their business?
Knowlton: Another great question. In terms of why post-acute has been largely left out of some of the major EHR regulations, it all stems back to the fact that the incentives to adopt EHR were aimed at other care spaces for a variety of reasons. The federal agencies incentivize and develop programs to certify technologies in care spaces such as acute and ambulatory, to encourage the adoption of electronic means to record patient data and patient progress against care plans, and to become interoperable. Their recently launched rules mandate giant leaps in interoperability technology and policy for providers and vendors in those spaces.
Post-acute providers have a great opportunity to take advantage of the information-sharing and interoperability rules that have recently been put upon acute and ambulatory care providers. By plugging into these newer, more advanced mechanisms for exchanging data on behalf of the patient under care, a post-acute provider can build a moat around its business by successfully making sure that providers in other care locations have access to the information they need to do their job in caring for patients.
While acute and ambulatory care settings could increasingly desire to move into post-acute, good post-acute EHR systems are built with the specific needs of post-acute care providers in mind. As long as the interoperability is in place between acute and ambulatory and post-acute care settings, providers have a much better opportunity to prove their value and avert any potential competitive responses from other care delivery organizations.
In fact, this is one of the biggest reasons Cerner chose MatrixCare as its go-forward solution for home health and hospice providers in 2019 – interoperability and usability of the technology is the future for post-acute care.
Entering this year, no one knew fully what to expect in 2021. What has been the biggest surprise in home-based care since the year started, and what impact do you think that surprise will have on the industry for the remainder of the year?
Knowlton: The existence of technology and interoperability have accelerated some of the trends that were already in existence pre-pandemic. Value-based care has long been about keeping patients healthy in and out of the hospital. The rapid emergence of models for delivering extra care in a patient’s home has been surprising, not necessarily because of the emergence and existence, but because of the speed with which it has gained popularity.
The simultaneous rises of telehealth and interoperability in the post-acute care space and additional data delivery systems will continue to accelerate into 2021 and beyond. The impact will be largely positive for home-based care organizations as in-home care is put on the national stage because of its importance and success.
Editor’s note: This interview has been edited for length and clarity.
MatrixCare, provides innovative software-as-a-service solutions for home health, hospice, palliative care and private duty providers. To learn more about how MatrixCare can help your organization, visit MatrixCare.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].
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