Getting value-based care right with the right data and partner

What is data aggregation in health care?

Data aggregation in health care is the process of collecting and distributing information from various sources so you can make decisions based on a more complete picture of a patient’s health than you could by using a single data source. As the amount of available health data grows, access to aggregated, person-centered data is crucial for family physicians and primary care practices.

Turning data into actionable information

Aggregating alone does not make data useful. Creating a more effective information sharing ecosystem for family physicians requires more than simply being able to access the data. Data should be clinically relevant, actionable and delivered in a timely, accurate, secure and efficient manner. This vision only starts with data aggregation. That first step must be followed by processing, packaging and presenting the essential data in a way that lets physicians easily extract the information they need to inform care delivery decisions.

Data aggregation and administrative burden

Collecting, ingesting and managing data is important to primary care, but it shouldn’t be the job of family physicians. Ideally, data aggregation should consist of necessary data being automatically delivered into the EHR and integrated cleanly into existing workflows, enabling physicians to simply use the information to support clinical interpretation and decision-making. 

Why data aggregation is important for value-based care success

While data aggregation is important regardless of how care is paid for, practices and physicians engaging in value-based payment (VBP) models—unlike those in fee-for-service (FFS)—are held accountable for outcomes, driving a greater need for data aggregation.

Success in value-based care requires that physicians have ready access to the aggregated, person-centered data that supports key functions in value-based care, including:

• A holistic view of patients. By aggregating data from EHRs, claims, pharmacy records and other sources, physicians can gain a more comprehensive view of a patient's health, supporting effective and personalized care plans that better address an individual’s medical, behavioral and social needs.
• Care coordination. Effective care coordination requires giving family physicians insight into the range of care services patients are receiving from other care settings.
• Proactive identification. Aggregated data can provide family physicians with insights to identify high- and rising-risk patients who need outreach or interventions, enabling proactive care management.
• Performance measurement. Family physicians need to monitor their individual and/or organizational performance throughout the year in relation to agreed upon goals and metrics.

What are Health Information Exchanges and Health Data Utilities?

There are several types of data aggregation entities, but the primary and most widely used are Health Information Exchanges (HIEs) and Health Data Utilities (HDUs). These entities provide:

• A patient-centered and vendor-agnostic framework facilitating the bidirectional exchange of patient health information
• Nonproprietary infrastructure for aggregating multiple sources of data and facilitating real-time, bidirectional data sharing between payers, physicians, hospitals, pharmacies labs and public health agencies to inform clinical care
• Reduced burden around connecting individually with multiple payers and providers, instead allowing data to be sent and received from a single entity

Key differences between HIEs and HDUs

HDUs differ from HIEs in capabilities rather than purpose. HDUs represent an evolution of HIEs, usually offering additional types of data (e.g., CBO data) and capabilities that support a more comprehensive approach to patient care, encouraging the use of data rather than merely its exchange.

HDUs are usually built on existing HIE infrastructure and exist on a gradient of maturity, as shown below.

Other types of health data aggregators

Other health data aggregator types include:

• Clinical Data Registries, which record information about patient health status and the care they receive, typically focusing on a defined population with a shared health status or treatment
• All-Payer Claims Databases, which aggregate claims from multiple payers
• Qualified Clinical Data Registries, which collect and submit MIPS data to CMS on behalf of physicians
• Community Information Exchanges, which act in a similar manner to HIEs, but with a focus on social needs and connection between community-based organizations (CBOs)

Ideally, HIEs/HDUs and VBP conveners are utilizing these and other aggregators to bring together disparate data to create a robust and comprehensive source of patient health information

TEFCA and information exchange

The Trusted Exchange Framework and Common Agreement (TEFCA) is a framework for supporting nationwide health information sharing, providing rules of the road for Qualified Health Information Networks (QHINs), which are the entities that will serve as hubs for information exchange.

HIEs/HDUs can serve as QHINs (eHealthExchange is a national HIE that has been approved as a QHIN). Importantly though, QHINs are designed to support the exchange of health data but are not themselves the solution to the larger need for robust data aggregation capabilities, which include EHR and workflow integration.

In addition, HIEs/HDUs and VBC conveners can be participants or sub-participants in TEFCA, connecting to approved QHINs to support nationwide data exchange.

What are value-based care conveners?

Value-based care conveners are organizations designed to help physician groups participate and succeed in value-based arrangements. Sometimes called ACO or value-based payment conveners, they are a rapidly growing segment of the U.S. health care system. Their focus includes turning gathered data into user-friendly, actionable insights. Unlike HIEs and HDUs, conveners are typically privately owned companies.

Conveners partner with care delivery organizations—particularly independent primary care practices—to support their adoption of value-based care.

Unlike a typical vendor or consultant, essential to the definition of a VBC convener is the alignment of incentives between the practice and the convening entity, tying convener business models to provider performance under value-based arrangements. There is significant variation in the partnership models used by conveners, though most engage in multi-year contracts with practices in which the convener shares in a portion of the generated savings.

Most VBC conveners tend to provide a similar set of services to practice partners, though the quality and specifics vary widely. VBC conveners rely, in part, on data from other entities—including HIEs and HDUs—to support their services. Common offerings provided by conveners include:

How to partner with health care data aggregators

All practices will need supportive technology capabilities to effectively participate in VBC and manage the health of various patient populations. The sophistication of your practice, though, will inform whether you need the broad array of supportive services provided by an convener (e.g., financial, administrative, technology and clinical) or if you can simply connect to HIEs/HDUs to get the data needed to inform population health management using homegrown or vendor solutions for analytics and reporting.

Practices should consider some of the following factors as they evaluate their use and partnership strategy.

• VBC maturity. As experience with value-based payment models increase, a practice may find that it no longer needs to partner with a convener after developing the necessary internal capabilities and knowledge to support data ingestion and analysis from an HIE/HDU and other sources directly.
• Practice and population size. Smaller practices, even those with significant experience in VBC and the necessary internal capabilities, may find that they will need to continue relying on conveners or other external partners (e.g., CINs or ACOs) to achieve the scale needed to participate in VBC, as models typically require a minimum number of aligned patients.
• Entity availability and robustness of available data aggregators. A practice’s location can dictate whether they have access to a robust HIE/HDU or attractive convener partnership options.  

Use and partnership strategies may evolve over time as these factors change.

Tips for working with data holders

• Develop clear roles and protocols. Every member of the team plays an important role in ensuring the flow of information supports optimal patient care. Your practice’s office manager, for example, could act as the point person for HIT issues and coordination with data aggregation partners. Larger practices may make this a dedicated role.
• Use the right technology and partners. Small practices, in particular, face a high administrative burden participating in VBP. Picking the right tools and partners can make all the difference. If a partner or tool isn’t working, move on; there are often many options available.
• Provide feedback to technology partners. Both conveners and data aggregators are responsive to feedback when things aren’t working. Don’t be afraid to be the squeaky wheel.

AAFP members who are interested in discussing technology and clinical optimization can join a member interest group on technology.