The growth of population health management (PHM) as the means to improve health outcomes has led to an increased interest in analytic technologies and services. A recent survey of 1,000 senior business and technology executives revealed changing market perceptions and trends when it comes to the use of analytics in healthcare.
Nearly 70 percent of those surveyed view “big data” as very important or critical to business success, up from 55 percent in 2014. In addition, 72 percent of companies that have launched some form of big data initiative say results have exceeded expectations. The big data analytics market is actively growing, increasing 42 percent over the first quarter of 2016.
The Affordable Care Act (ACA) has incentivized healthcare providers to move towards value-based care (VBC) payment models, reducing their use of traditional fee-for-service models. The long-term success of VBC depends on a robust health IT infrastructure to launch population health management and clinical analytics technologies. The benefits of implementing and optimizing this type of system include:
1. Overcoming reimbursement-based challenges: Information storage and reporting are essential for providers looking to show results. As Medicare changes payment systems and incentives, providers must adapt by leveraging clinical analytics and business intelligence tools. This can help in various ways:
- Payer Underpayment: Underpayments can lead to inefficient claims auditing as well as higher billing and contract administration costs. By effectively using data analytics, providers can ensure payment accuracy and full reimbursements.
- Data-driven approach: A strategic, data-driven approach helps in the claim assessment process, increasing accuracy.
- Pricing Transparency: As employers demand increasing transparency, providers must strive to maintain a balance in cost and value while not compromising on quality.
2. Advanced patient care: A successful PHM program offers real-time data insights to clinicians and administrators to fill in gaps between existing service offerings. It is particularly useful in cost savings for chronic disease populations. More specific positive results include:
- Flexible IT: A backend that collates information from different sources including clinical data, medical histories, tests, images and records of procedures and diagnoses, and medication and allergy information, as well as laboratory, inpatient, and ambulatory records. In essence, it is a one-stop patient information shop that facilitates more informed decision making at the point of care, contributing to better results.
- Decision support: By widening the access of data beyond the individual, analytics contributes to better decision making and more personalized care.
- Customer experience: Engagement, intimacy and relationship building are vital aspects of the overall experience customers desire. Health providers must use analytics to improve care as well as the overall customer experience.
3. Operational and Clinical Quality Improvement: As the needs of providers continue to change, data analytics provide a more customized business intelligence strategy that includes data governance and. The Healthcare Information and Management Systems Society (HIMSS) has developed a value suite called STEPS that offers enlightens providers on the new perspective on ROI measurement while elaborating ways to maximize value to patients, providers and communities. Benefits of an end-to-end PHM model: While predictive analytics become more complex and sophisticated, providers must understand its role in improving VBC delivery and clinical outcomes. Organizations can aim to reduce spending and redirect finances to direct patient interventions. Here’s elaborating on a few benefits:
4. Positive ROI: By bringing together clinical, financial and operational data from different sources, providers aim to improve efficiency and patient care. This requires better care management and a well-oiled delivery system integrated with well-managed partners. The Healthcare Financial Management Association (HFMA) surveyed 146 senior financial executives to view their readiness for VBC and found that more than 50 percent of the executives surveyed reported that their systems achieve positive ROI from value-based payment models. They found that key enabler data competencies ranked highest in likelihood of enabling success in the organization’s abilities to take risk-based arrangements. Physicians and providers need to think about effectively using technology to adopt PHM and improve health outcomes.
5. Enterprise data warehousing (EDW): EDW is crucial for gathering data from different point sources and further aggregating and normalizing this data to transmit useful information that helps enable preventive care, evidence-based disease management, clinical integration, and effective participation in VBC initiatives.
6. Advanced clinical, workflow, operational, and patient safety applications: Establishing a uniform platform base can help manage the huge volume of available data. Subsequent allocation of resources and reporting can help providers take advantages of resources provided by the federal government, like the Health Resources & Service Administration grants.
7. Holistic approach: Providers are seeing the value of understanding and interpreting information from various nontraditional sources—such as socio-economic factors and specific physical health-related factors—and administering care at a holistic level rather than in isolation.
Providers will need to rely on vendors to provide an IT infrastructure which that complies with these deliverables and collects and analyzes information from disparate sources, facilitates data searches, and provides round the clock analytics to aid better decision making. Providers must understand the various opportunities PHM and analytics bring in cost saving if smart investments are made in establishing a strong infrastructure to support the programs. While value-based care models incentivize them to think of innovative approaches, they must also rely on long-term partnerships that encourage integration at a process and human workflow level to gain lasting rewards and improve patient outcomes.