With the turn of the new year and the new presidential administration, the potential repeal and replace of the Affordable Care Act (ACA) has dominated headlines and payers have been left in a state of uncertainty on several major issues. From the 20 million people that could become uninsured, to the removal of the individual mandate and corresponding spike in premiums, health plans are bracing themselves for unknown market instabilities.
However, payers should not lose sight of what they can control today: how to leverage data in a healthcare economy that is defined by value over volume. We connected with Bruce Carver, associate vice president of payer services, to shed light on how critical it is for payers to have a strong data-driven strategy in 2017 to prepare them for forthcoming regulatory changes.
Payers play a unique role in healthcare as they can offer providers access to robust data on their member population. That data, however, is not actionable without proper analytics that can identify potential cost savings via patient care gaps and high cost populations. In 2017, here are three evergreen cost saving areas to focus on:
- The individual market – trend where risk existed over the last three years to understand what you can take on from a cost perspective in the future. This retrospective analysis will allow payers to make strategic decisions on how to approach and cater to specific member populations, like those suffering from chronic diseases.
- Gaps in care – identify gaps in care that are driving down value, work more closely with providers and outline strategies that can start to drive down the bad debt caused by these gaps. Collaboration with providers is the only road to quality to create a holistic patient record. Start collecting information on everything from claims and demographics to clinical data generated by the electronic health records of multiple providers.
- High costs –establish a trajectory of where you are spending the most and use your data to analyze where that spend may be in the future and to course-correct throughout the year. No regulatory mandate will ever change the fact that payer organizations need to have a strong understanding of their profits and losses. Is there an at-risk patient population that needs more interventional resources now before they progress to a chronic condition? Are some of your high cost groups associated with medication adherence issues? These are just some questions to ask and address when examining spend vs. value.
Trends in Review: Looking Ahead to HIMSS17
Each year, the HIMSS conference brings together the brightest health IT professionals, clinicians, c-suite executives and vendors to discuss cutting-edge innovations and developments in the industry. With HIMSS17 right around the corner, here are the top three trends that we’ll likely see dominating the headlines:
- Big Data and Analytics Will Continue to Push the Industry Forward – A recent poll conducted by Healthcare IT News shows that Big Data and Analytics will be two of the most talked about topics at HIMSS this year. This has been a continued trend as there have been major investments in this field. In fact, a recent IDC report found that the analytics market will reach $43 billion by 2020. Analytics is a crucial tool for healthcare organizations, as it offers them a holistic view of their patient’s outcomes and cost saving opportunities within their supply chain. Healthcare organizations are continuing to invest in solutions that lend insights to improve patient outcomes while keeping costs down.
- Revolutionize Data Sharing – Sharing data securely will continue to be a focal point as the industry continues to track towards quality outcomes for patients. Despite progress, this effort has not been met without challenges. In fact, 45 to 54 percent of physicians reported burnout from using EHRs. Many believe blockchain, which is a sequence of every transaction made in the patient’s history, is the solution. John Halamaka, chief information officer at Boston-based Beth Israel Deaconess Medical Center, recently spoke about its potential and stated: “it’s the right time in our history to take a fresh approach to data sharing in health care.” The conference will shine light onto the industries willingness to work towards a new form of data sharing.
- Staying Competitive via Payer-Provider Collaboration – As the industry becomes more patient-centric and value-driven, payers and providers will need to increase focus on collaboration. Patients are becoming even more engaged in their own healthcare and will look to providers who can offer the best value and experience for their service. Health plans, a recent Deloitte report noted, will need to harness advanced information technology to assist in important interactions with members to offer value. Through payer-provider collaboration, organizations will have the opportunity to stay competitive and achieve patient satisfaction.
Amidst new legislation and investment in the health IT sector, tracking towards value is full steam ahead. Payers and providers will need to invest in solutions that help them achieve the triple aim. If you plan on attending this year’s conference, make sure to stop by and visit us at MP34 to learn more about our cloud-based payer and provider tools that help uncover business insights for nearly 1,500 healthcare organizations.
How to Liberate Data Insights
In last week’s blog post, we explored how to make the most out of analytics investments. For this week’s blog, we want to continue that conversation. Data is a useful resource and the industry agrees, with 70 percent of healthcare organizations seeing its value. Although useful, there are many challenges in addressing data including how to best utilize it.
One useful way to leverage data analytics is to create its own department. Often times, healthcare organization’s data is confined to departmental silos that prevent the delivery of actionable insights to the hands of key decision-makers. This self-servicing of analytics democratizes data and insight by providing the right insights to the right users at the right time. Here’s how healthcare organizations can succeed with their own analytics department:
- Find Departmental Business Leaders and Champions
With an analytics department there comes a lot of data insight to manage. This requires leadership and process change, not just dashboards to sift through. Data champions and business leaders are the driving force that will integrate insight into their daily, monthly and/or quarterly management processes. When engagement with analytics comes from the top it is much easier to sustain and ensure that analytics is integrated throughout the organization.
2. Build Trust with Data Governance
Data is nothing without the organization behind it. To gain that trust, it’s important to provide reliable data that business leaders and champions can use to empower physician and clinical teams towards their goals. To ensure data trust, there needs to be proper governance, documentation and data mapping to help build trust and transparency throughout the organization.
To learn more about leveraging analytics, check out our latest whitepaper here. If you are interested in ways we can help you on your analytics journey, learn more about our enterprise analytics options.
How Health Systems Can Achieve ROI in Analytics Investments
The journey to value-based care is filled with challenges, especially as it relates to measuring quality metrics. This challenge can be difficult to overcome without the right tools and skillsets but analytics can be an invaluable asset to help track and benchmark progress towards value. In fact, this is already becoming a widely-adopted tool, with the healthcare analytics market expecting to reach $42.8 billion by 2024. In this week’s blog post, we’ll outline the necessary steps healthcare organizations can take to ensure return on investment (ROI) with analytics. With nearly every healthcare organization somewhere along the value journey, it’s important to keep in mind that each step should be catered to help meet specific business objectives. Here are three guidelines to start:
1. Lead with Business Use Case, Not Technology
A successful analytics project begins by identifying key stakeholders and understanding their needs for reporting and analysis. Think of the following question when getting started: what business problems are we trying to solve and how can enterprise analytics create value? Analytics programs need to be built with problems at the center.
2. Achieve Quick Wins
Starting small is key. Sifting through and analyzing data can be a large and daunting task, so it’s important to remain focused at the start of your project and then expand. Focus on one or two small use cases such as medication adherence or hospital readmissions. Once those initiatives are deployed, set realistic metrics and timeframes to properly measure progress. If progress is being made, make sure to continue driving the initiative and look for additional growth opportunities.
3. Create a Data-Drive Culture
Healthcare organizations typically work in siloes, especially as it relates to analytics. Each department has various levels of competency and integration of analytics tools. Establishing a dedicated analytics department that is separate from others instills its importance and creates a data-driven culture. Through centralizing analytics, the healthcare organization can spread expertise across the organization, standardize analytical platforms and create governance for consistent calculations and metrics.
To learn more on how to make the most of your analytics investment, check out our latest whitepaper here. If you are interested in ways we can help you on your analytics journey, learn more about our enterprise analytics options.
A Data Scientist’s Response to the Debate Over Patient Data Ownership
A New York Times op-ed, The Health Data Conundrum, by Eric Topol and federal prosecutor Kathryn Haun, argues that patients should have full ownership of their medical records, especially during a time when data hacking is the new norm. The piece has received mixed reviews over the past week, most industry thought leaders believing it was a not well thought out response to a complex issue. In this week’s blog, our very own Virginia Long, PhD, Predictive Analytics Scientist, dissects the op-ed and the potential dangers from the suggestions Topol makes.
Personal healthcare records have been an exhausted discussion with healthcare. From data blocking to MACRA, there have been many challenges and opportunities to leverage health records to make more informed decisions around care and empower patients throughout their healthcare journey. The op-ed adds to this long discussed topic, but only touches the surface on patients owning their records. It’s an impractical solution to a wider-issue. Emphasizing data security as the main reason for patient-owned data isn’t a strong argument, in fact, there is no way to remove all security vulnerabilities.
Within the piece, Topol notes:
“Patients have shown an overwhelming willingness to share their information for altruistic reasons (which far exceeds the track record of doctors and health systems when it comes to sharing data)."
Unwillingness on the part of healthcare organizations is cited as a drawback to the current state of healthcare data ownership, however, personal ownership of data is not going to simply give patients the ability to share. In fact, when patients are able to “share” data for research they are actually just allowing the data which is collected, stored and kept securely by their provider to be used in research—they are not actually “owners” of the data. Many patients do not have the ability, resources or motivation to adequately edit their health record. A wholesale shift in responsibility of data from healthcare organizations to the individual is fraught with challenges. If there was a reasonable way to keep, maintain and share medical data in a reliable way, then this would be a great idea. However, it’s not realistic to propose that the answer to having secure and accurate data is by putting the responsibility through “ownership” in an individual patient’s hands.