Conf42 Machine Learning 2025 - Online

- premiere 5PM GMT

Overcoming Key Challenges in Value-Based Care through Cloud Solutions

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Abstract

As healthcare moves towards a Value-Based Care (VBC) model, the focus is shifting from the volume of services provided to the quality of patient outcomes. This transition emphasizes preventive care, chronic disease management, and patient engagement, with incentives tied to achieving positive health outcomes rather than the number of services rendered. However, implementing VBC presents several challenges that can hinder its effectiveness, including data fragmentation, complex reporting, care coordination gaps, patient engagement barriers, risk adjustment issues, and ever-changing regulatory requirements. This session explores how cloud-based solutions can address these key challenges by providing scalable, interoperable, and secure infrastructures that support VBC initiatives. Cloud platforms enable seamless data integration across disparate systems, facilitating real-time access to critical patient information across different providers and care settings. For instance, cloud-native technologies such as FHIR APIs and HL7 integration engines ensure the interoperability of electronic health records (EHRs), lab results, and remote monitoring data, thereby overcoming data fragmentation. Complex reporting requirements in VBC programs can be automated using cloud-based analytics platforms, significantly reducing the time and effort involved in tracking performance metrics like HEDIS, STAR ratings, and ACO performance. Real-time dashboards also improve decision-making and compliance with CMS and payer contracts. Cloud solutions also foster improved care coordination by enabling collaborative platforms that allow healthcare providers to access and update patient records simultaneously. Moreover, AI and machine learning applications on the cloud facilitate predictive analytics for risk stratification, helping healthcare teams proactively manage high-risk patients. Additionally, cloud tools improve patient engagement by enabling automated communication and integration with wearable devices, resulting in better adherence to care plans. With built-in HIPAA, HITRUST, and SOC 2 compliance, cloud platforms ensure robust data security, reducing the risk of breaches and simplifying audit processes. Through these innovations, cloud technology can empower healthcare providers to navigate the challenges of VBC, driving improved patient outcomes at lower costs.

Summary

Transcript

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Hello guys. Thanks for joining me today. This is Bandana Muah, and I have more than 19 years of IT industry experience on variety skills and roles. Currently, I'm working as a senior software engineering manager, and today I'm going to talk about some of the key challenges we have on value-based care. Implementation in healthcare and how solutions or basically cloud-based solutions help overcome these challenges. Okay. Let's talk about what is a value-based care program and. How the cloud solutions help overcome this? Value-based care represents a fundamental shift in healthcare delivery from volume to value with payment based on patient outcomes rather than service quantity. This approach emphasizes preventative care, effective chronic disease management, coordinated delivery, and patient engagement. However, organizations face significant implementation challenges that cloud solutions can uniquely address. This presentation explores how cloud technologies provide the infrastructure, scalability, and in Interability needed to make value-based care successful in today's complex healthcare landscape. Let's talk about value-based care fundamentals transitioning from traditional fee for service. That is more services equal to more revenue, to the quality-based reimbursement where providers earn incentives for meeting benchmark, reducing cost, and improving satisfaction. This emphasizes preventive care strategies, comprehensive chronic disease management programs, coordinated care across multiple providers and active patient participation in healthcare decisions. Success requires tracking numerous quality metrics, including clinical outcomes, cost efficiency, patient experience measures, and population health indicators across diverse patient populations. While the VBC model promises better care at lower costs, implementing it requires substantial changes to workflows, technology, infrastructure, and organizational culture. Healthcare system must overcome several significant challenges to realize its full potential. Now let's move on to understand the data fragmentation challenges. Patient information exists in siloed systems across multiple providers, including electronic health records that EHRs, laboratory systems, pharmacy databases, billing platforms, and specialty care records. This fragmentation creates blind spots in clinical decision making, impacts care coordination, and makes comprehensive quality reporting nearly impossible. Cloud-based solutions helps create unified data lakes that aggregates information from D Dispar sources into a single accessible repository. Fire based APIs and HL seven integration engines enable real time bidirectional data sharing between previously INCAP incompatible systems, creating a comprehensive patient view data normalization services, standardized information from different sources, making it usable for analytics and reporting. By leveraging Cloud Solutions healthcare organization can eliminate data silos, creating a holistic view of patient journey that supports true value-based care. Okay, now let's talk about how cloud solutions help in streamlining complex reporting requirements. Automated extraction from multiple sources into cloud. Data lake is the best example where every organization might be seeing the benefits today processing using the cloud solutions. That is AI driven data normalization and metric calculation. Utilizing cloud for analytics. That is real time dashboards. Identify care gaps and opportunities. And submissions of automated report to the organizations such as CMS or payer organizations, other and other stakeholders, value-based care programs, demand reporting on dozen sub metrics such as STAR rating, a CO performance, creating administrative burden, cloud platforms like. AWS Health Lake, Microsoft Azure for Health and Google Cloud Healthcare API automates these processes reducing manual work, while improving accuracy and timeliness With cloud-based analytics, organization can identify care gaps immediately rather than with discovering them during the retro spec. Two reviews, enabling proactive interventions that improve outcomes and performance metrics. Now let's talk about how Cloud solutions helps bridging care, coordination gaps, unified access. Basically, role-based platform ensures team members sees the relevant information while maintaining security and compliance workflow integration. Cloud systems embed care pathways directly into clinical workflows, guiding evidence-based decisions at the point of care. Intelligent alerts. Automated notifications, alerts team members about critical changes to patient status, mission appointments, or care plan deviations. Coordinating care across specialists, primary care hospitals, and community service has. Traditional Will difficult without integration. Integrated systems. Cloud-based care management platforms creates a unified environment where all stakeholders can collaborate in real time. When specialists, PCPs, nurses, and social workers can simultaneously access and update shared care plans, communication errors decreases, and care transition becomes seamless, leading to better outcomes and reduced costs. Now let's talk how Cloud solutions helps in enhancing patient engagements. Digital outreaches, such as automated SMS, email and app notification for appointments and screenings. Two-way communications such as securing messages with the care team members. Remote monitoring by wearable integration for continuous. Healthcare tracking self-management by patients where patient portals for accessing records and care plans. Patient engagement barriers represent a significant challenge to value-based care success. Patient may struggle to follow care plans, manage medications, or attend appointments, particularly when social determinant of health creates additional obstacles. Cloud solutions enable scalable, personalized, patient communication tools that meets patients where they are. These platforms can be tailored to patient preferences, literacy levels, and languages, making healthcare more accessible to diverse populations. Now let's talk about powering the risk stratification using ai. Helps in data aggregation, comprehensive patient profile from multiple sources. Machine learning identifies patterns and risk factors, helps in access actionable insights delivered to care teams. Providers in value-based arrangement often struggles with risk adjustments and managing diverse patient populations. Traditional risk models may not account for all variables, particularly social determinants of health that significantly impact outcomes. Cloud infrastructure provides the computational power needed for sophisticated AI driven risk stratification. These models can identify risk, can identify high risk patients by analyzing vast data sets. Including clinical data, claims history, social factors, and even behavioral patterns, enabling truly proactive care management. Now let's move on to the security and compliance area where, how cloud solutions help leading cloud providers offer hipaa. Hit trust and SOC two compliance frameworks out of the box. Reducing the burden on healthcare organizations to build compliant infrastructure from scratch. Comprehensive security measures encryption at rest in data transition. Granular access controls continuous monitoring, advanced threat detection systems that exceeds most on-premises capabilities. Auditability. Automated logging and monitoring tools track all data access and changes, creating audit trails that simplify regulatory reporting and quickly identify potential security issues. Healthcare organization face increasingly complex regulatory requirements with frequent changes to the CMS rules. A-C-M-A-C-U models and payer contracts. Cloud solutions help. Navigate this complexity by providing robust security frameworks and compliance tools that adopt changing requirements. Now let's talk about a cloud-based solution, which I recently implemented in my organization, which is we named it as value-based care data enable enablement engine. Which uses AWS Cloud solutions and has been providing tremendous support and value to the Our Nation. Some of them are listed here. These solutions gives a unified view across systems, helps with the data to give the complete patient journey. It helps in real time. Metrics against contracts helps in documenting or onboarding the providers, delivering the value and accuracy in the reimbursements. The data provided by these solutions helps. Proactive intervention opportunities in care management. This helps in better experience. Through coordinated care, this solution has been helping our nation save cost of implementations or onboarding new providers by 25% or more savings. Contract Enable data extract engine demonstrate how cloud solutions can transform value-based care performance. This system aggregates data from desperate sources to create unified view of contract performance against key metrics. The cloud-based architecture allows for seamless scaling as data volumes grow while maintaining consistent performance by automating data extraction nine. Standardization. The system has reduced reporting time by 75% while improving accuracy by 30% directly impacting financial performance under value-based care. Now let's move on to the best practices we can follow while implementing value-based care programs assessment and planning. Evaluate current data systems. Define specific VBC goals and identify critical integration points. Create a phase approach. Prioritizing high impact use case first, involve critical stakeholders from the beginning to ensure solutions, address real workforce needs. Choose between a multi-cloud hybrid or single vendor approaches based on your organization's need. Design data governance framework that maintain compliance while enabling analytics, implement identity management solutions that support appropriate access across organizations integration and adoption Where. Use fire based APIs to standardize data exchange. Develop comprehensive training programs for all staff levels, create feedback mechanism to continuously improve the system based on real world usage pattern and user suggestions. Successful implementation requires thoughtful planning and strategic approach. Organizations should start with clearly defined outcomes and build incremental. Incrementally focusing on demonstrating value at each phase, or rather than attempting a complete transformation at once. Now, let's talk about the feature of cloud enabled value-based care solutions. If you look at the screen, you see the tremendous cost reduction in the IT implementation, which is around 40%. And 68% efficiency, increasing efficiency in reporting 3.2 times return on investment, 24 by seven availability. So let's deep dial a little more. You can see the sources of these. Data or the facts on the bottom of the each item. So in the cost reduction, healthcare organizations have seen an average operational saving of 40% after migrating to cloud platforms. This is primarily due to the reduced IT infrastructure, lower physical data storage and minimized server maintenance costs, reporting efficiencies. By automating reporting processes, cloud platforms have helped healthcare organizations reduce time spent on quality reporting by 68%. Real time data extraction analytics, and integration with regulatory frameworks such as and a CO have streamlined this process. Return on investment cloud adoption in healthcare has led to an average of three. Point two times the return of investment. This is driven by operational efficiency improvements, faster and more accurate decisions making and reduced administrative overhead. Cloud solutions are available 24 by seven, which helps access to critical healthcare data enhancing care coordination. Enabling timely inter interventions and improving patient outcomes through the real time monitoring. I hope this session was helpful and if you have any questions, you can reach me on LinkedIn. Thank you for being here.
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Bandanawaz Mulla

Senior Manager Platform Strategy @ Health Care Service Corporation

Bandanawaz Mulla's LinkedIn account



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