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Value-Based Care and COVID-19
Predicting the needs of long haulers in a value-based care environment
Tracy Milanette, Predictive Risk Segment Lead, IQVIA Healthcare Solutions
Julianne Migely, Senior Director, Predictive Risk, IQVIA Healthcare Solutions
May 20, 2021

Value-based care (VBC) delivery models have long been a useful risk mitigation tool for many as they minimize patient care disruptions and incentivize providers to improve their care quality. This has been especially true since the rise of the COVID-19 pandemic as new, unexpected factors have begun to add more elements of risk and uncertainty in care delivery across the ecosystem in addition to a rise in telehealth and other connected health services. When healthcare providers utilize innovative data and analytic strategies, they can better manage some of these new COVID-19-related complications and optimize their VBC delivery models.

For example, the surge of COVID-19 patients, coupled with the loss of revenue streams from patients who avoided hospitals and doctors’ offices, has created financial challenges for many providers. One survey from the American Medical Association (AMA) found medical practices saw a 32% average drop in revenue during the pandemic.

In order to generate the best results for themselves and their patients, providers need to be able to make informed decisions about COVID-19 care, but how can they do that when they are unsure about the unique health factors COVID-19 survivors will bring? Or the long-term impacts of the disease? These unprecedented times has made it more important than ever for providers to use data-driven analytics to be successful in creating a VBC model of patient care and reimbursement.

What we don’t know

VBC contracts pay providers based on their ability to deliver cost-effective, quality care with incentives for better results. But uncertainty about the long-term health implications of COVID-19, and its potential impacts on patients with other chronic conditions, introduces new questions providers may have difficulty answering without the right data.

The lack of knowledge about the cost of care for long haul COVID-19 sufferers, or the best treatment paths for patients with other chronic conditions such as diabetes or cardiovascular conditions, could put providers’ value-based payments and incentives at risk.

Providers need data to help shed light on the potential long-term impacts of COVID-19 and corresponding cost of care across different patient populations. They also need these data to help understand which treatment strategies deliver the best outcomes and which result in the best care at the lowest cost, while delivering an excellent patient experience.

Yet these are the hallmarks of a successful VBC model, so how can providers best prepare themselves to answer these unknowns?

Adding external datasets to internal data

The percentage of patients who will suffer long-term consequences of COVID-19 is still relatively unknown to date, which means providers cannot count on their own patient data to identify trends and best practices for their care. They need broader, more diverse datasets which allow them to monitor trends across patient populations, practices, and care settings.

The right combination of data can help them more accurately assess the most at-risk populations, identify early warning signs of COVID-19-related health events, and compare treatment trends to determine which will deliver the best outcomes. These insights can help providers reduce risks in their payment contracts and ensure the best care for their patients.

The addition of external population-driven analytics can help providers achieve these goals. IQVIA offers several external datasets to help providers address some of these critical unknowns:

  • IQVIA’s All-Payer Medical Claims Database features near census-level deidentified claims data which includes patient-level diagnoses, procedures, and provider panel demographics from professionals and healthcare facilities across the country.
  • IQVIA’s Longitudinal Prescription Database offers near real-time information about the prescriptions drugs and therapies being prescribed in different regions, and the persistence and compliance of those filled prescriptions.
  • IQVIA’s PharMetrics Plus Database features fully integrated, longitudinal, closed claim real world data on commercially insured patients across the U.S. It provides high-level details about every healthcare event that occurred during a specific time, including where and when healthcare visits occurred, where diagnoses were made, where prescriptions were written, and any labs and procedures that were conducted. Because the claims are adjudicated, the cost data is more accurate and complete, providing a clearer picture of health resource utilization and total cost of care analysis.

Providers can use external datasets like these to better track COVID-19-related trends across the nation, with enough detail to understand the long-term impacts of the pandemic on patients within different geographies, age groups, chronic conditions, and socioeconomic populations.

As no one yet fully understands how COVID-19 will affect different patient populations in the years to come, using external datasets in combination with internal data is an important step in accelerating access to that knowledge. When providers use diverse datasets to monitor COVID-19 trends, they can make more informed decisions about value-based contracts and how best to meet the needs of patients.

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