The complex and highly fragmented healthcare system in the United States makes it difficult to develop a nationwide approach to value-based healthcare, according to a new report published by the Boston Consulting Group that called for better data standards and patient registries.
The report looked at efforts to improve health outcomes--while also maintaining or lowering costs--in the health systems of 12 countries: Australia, Austria, Canada, Germany, Hungary, Japan, the Netherlands, New Zealand, Singapore, Sweden, the U.K., and the United States.
For each it asked two key questions:
- To what degree are a country's clinicians, government officials, and healthcare policymakers committed to creating and using a system of high-quality health data?
- To what extent is a national legal and IT infrastructure in place for collecting health outcome data and linking those data to issues of cost?
The report rated each country according to 35 criteria--15 at the national level and 20 related to disease registries. It outlined four key success factors:
Clinician engagement: The report said the greatest improvement comes when clinicians are responsible not only for collecting and interpreting data, but also leading improvement efforts.
National infrastructure: It looked for common standards for tracking diagnoses, treatments, outcomes, and costs at the patient level; a limited number of shared IT platforms; and a common legal framework regulating the use of patient data.
High-quality data: It said the most effective way to collect relevant data is through disease registries to promote more effective and cost-efficient care.
Outcome-based incentives: Data-driven incentive measures, it said, should spur changes in the way clinicians practice, payers reimburse, and suppliers of drugs and medical devices develop and deliver products and services.
The report's authors determined that Sweden was the most advanced country in implementing value-based care, followed closely by Singapore. Germany and Hungary, in contrast, were listed as the least advanced nations.
The report pointed to some excellent disease registries in the United States, including the Cystic Fibrosis Foundation Patient Registry, the Society for Thoracic Surgeons' STS National Database, and the American College of Cardiology's CathPCI Registry. It also cited the progress of some regional health providers, such as Kaiser Permanente and Intermountain Healthcare, in tracking outcomes among their patients and in creating incentives for clinicians to use best practices identified through outcome research.
And though the government is pushing the transition to electronic heath records, health information exchanges and accountable care organizations, Simon Kennedy, BCG's senior partner and managing director, told InformationWeek Healthcare that the Obama administration could do more. He pointed, in particular, to strong patient identification, provider identification, and data exchange standards.
New patient registries are being developed as part of the push to EHRs. The Minneapolis-area Hennepin Health Project, for one, is creating patient registries, data warehouses and patient dashboards to better coordinate care and provide Medicaid population health management.
And de-identified patient records for roughly 1.1 million diabetics are the basis of a new registry known as the Surveillance, Prevention, and Management of Diabetes Mellitus DataLink (SUPREME-DM). It's being shared between providers to develop more comprehensive prevention and treatment strategies. One of its goals is to standardize data definitions, a real problem when various terms are used to describe the same thing, Kennedy pointed out.