The Friday Five – Industry Reports
The healthcare industry is not in short supply of problems that need to be fixed or changes that need to be made. Oftentimes the process of change takes a while and the road can be long and winding. Thankfully all of the data collected and sifted through can be compiled into reports that can help lead the way to Oz. This week’s Friday Five highlights some of those reports along the yellow brick road lighting the way for better health data exchange, patient experience, health equity, interoperability, and social determinants of health to name a few.
As demand for more complete health data and data interoperability accelerates, the landscape of health information exchange (HIE) and health improvement is rapidly evolving in the public and private sectors. Civitas Networks for Health (Civitas) and the Maryland Health Care Commission (MHCC) identified the need to differentiate key aspects of emerging Health Data Utility (HDU) models more clearly. HDUs utilize existing technical and relationship infrastructures within and across states to bring together personally identifiable health data as well as population and public health data more comprehensively. The approach relies on multistakeholder data governance, trust, and advanced technical services. Fragmented and disparate data increases provider burden and impedes population health management, care coordination, quality improvement, patient safety, and value-based care. It thwarts the advancement of health equity and limits the utility of data in answering clinical and public health questions. Emerging HDU models are designed and implemented in alignment with states’ policies and priorities to address the needs of a broader health care ecosystem. An HDU can be defined as one or more entities, guided by a diverse stakeholder governance structure, that combine, enhance, and exchange disparate electronic health data sets for treatment, care coordination, quality improvement, population health, public health emergencies, and other public and community health purposes, supporting a specified geographic region.
About this Issue Brief
This issue brief outlines the history, current state, and drivers for the emergence and advancement of HDUs. It is intended to inform and support multi-stakeholder collaborations that bring about more robust health data and use cases with the goal of improving population and public health and advancing health equity. This issue brief intends to solidify the HDU concept bringing increased clarity to the role and function of HDUs.
After more than a decade of experience implementing value-based care (VBC) and payment arrangements in a rapidly changing health care ecosystem, it is important to consider lessons learned to inform continued improvement. The COVID-19 pandemic has underscored many of the persistent challenges facing the U.S. care delivery system, such as disparities in care and access, data exchange and availability, and unintended payment incentives, signaling the need to stop and contemplate the past to grow and adapt for the future. Thus, AHIP, the American Medical Association (AMA), and the National Association of ACOs (NAACOS) established a collaboration to identify renewed principles and voluntary best practices to advance broadbased participation and foster sustainable success.
Purpose and Use
This playbook is intended for those participants currently active in VBC arrangements as well as those seeking to participate in the future. It includes best and promising practices for overcoming key challenges associated with data sharing for VBC arrangements that persist today, taken directly from the expertise of those participating. It provides a bellwether to consider for voluntary adoption by VBC participants, which would reduce burden, positively impact care, and increase efficiencies.
The Sequoia Project identified two consumer engagement goals. Listening to consumers Acting on what we heard:
- The Sequoia Project’s vision is to make the right health information accessible at the right place and time to improve the health and welfare of all people.
- Consumers weren’t at the interoperability table and Sequoia decided to change that.
- The Consumer Voices workgroup was formed in Fall 2022 with a charter to share experiences, priorities, and recommendations for accessing, using, and sharing health data.
- The workgroup convened virtually on a monthly basis between December 2022 and April 2023. Participants engaged in polls and facilitated discussions to share perspectives at workgroup meetings. Poll results were analyzed and reported, and experiences were captured and recorded.
- This report is a summary of what we heard.
Social determinants of health refers to social factors and physical conditions of the environment in which people are born, live, learn, work, and play (e.g., employment, education, social and community context) that affect health and quality-of-life outcomes (1). Social needs, such as transportation, housing, and food security, are encountered at the individual level and reflect how social determinants of health (SDOH) affect individuals’ daily lives. An individual may have a range of social needs that affect their health (2). There is a large body of evidence demonstrating the link between social needs and health, and increasing evidence that addressing individuals’ social needs is associated with improved health outcomes (3, 4). The demonstrated link between social needs and individual health has spurred recent efforts to increase social needs screening and collection of social determinants of health data by providers in inpatient and outpatient settings (5, 6). Hospitals are uniquely suited to help address social needs and assist with transitions of care, particularly those serving high-risk populations. However, it is unclear if these data are collected routinely and whether they are captured in a structured format (i.e., using a screening tool or diagnosis codes) that would facilitate exchange (7). This data brief uses nationally representative survey data from the 2022 American Hospital Association (AHA) Information Technology (IT) supplement to describe the extent to which non-federal acute care hospitals collect and receive data on individual patients’ health-related social needs and how these data are used to promote patient and population health.
- In 2022, most hospitals (83%) reported collecting social needs data and 54% did so routinely. Routine screening was less frequent among lower resourced (i.e., small, rural, critical access, independent) hospitals compared to higher resourced hospitals.
- Nearly three-quarters of hospitals used a structured electronic screening tool to collect social needs data.
- More than half of hospitals (60%) reported electronically receiving social needs data from outside sources such as through health information exchange organizations (HIEs) (46%) and from other health care organizations (28%).
- Hospitals used social needs data they collected internally or received from outside sources for various purposes, such as to inform clinical decision making, discharge planning, and make referrals to social service organizations.
★ In 2022, 83 percent of hospitals reported collecting data on patients’ health related social needs with 54 percent of hospitals indicating they collect this information routinely.
★ About 60 percent of hospitals reported electronically receiving data on patients’ health related social needs from external sources.
The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the safety and quality of healthcare for all Americans. AHRQ develops the knowledge, tools, and data needed to improve the healthcare system and help consumers, healthcare professionals, and policymakers make informed health decisions. AHRQ accomplishes this mission by focusing on three core competencies: health systems research; practice improvement; and data and analytics.
The Patient-Centered Outcomes Research Trust Fund
In 2010, the Patient Protection and Affordable Care Act (P.L. 111-148) established the Patient-Centered Outcomes Research Trust Fund (PCORTF) and the Patient-Centered Outcomes Research Institute (PCORI). The Further Consolidated Appropriations Act, 2020 (P.L. 116-94) reauthorized the PCORTF and PCORI for 10 years, through 2029. The goals of the PCORTF are to fund Patient-Centered Outcomes Research (PCOR), disseminate PCOR evidence, build capacity for research, and develop a data infrastructure for PCOR to improve health and healthcare. PCOR provides decision makers with objective, scientific evidence on the comparative effectiveness of different treatments, services, and other interventions used in healthcare. The goals of the PCORTF are accomplished in coordination among three partners: PCORI, AHRQ, and the Department of Health and Human Services (HHS) Office of the Secretary, specifically the Assistant Secretary for Planning and Evaluation (OS-ASPE). Distribution of the PCORTF is authorized in section 937 of the Public Health Service Act, beginning in FY 2011, and continuing with the reauthorization in 2019. PCORI receives 80 percent of the funds appropriated or credited to the PCORTF each year to fund PCOR and disseminate its findings. The Department of Health and Human Services (HHS) receives 20 percent of the PCORTF funds each year. Sec 937 further directs HHS to transfer its share: 80 percent to AHRQ (16 percent of the total PCORTF) to disseminate PCOR and build research capacity and 20 percent to the OS-ASPE (4 percent of the total PCORTF) to build data capacity for research.