Driving Enterprise-Wide Change by Breaking Down Data Silos and Creating a Data-Driven Culture
This year’s Big Data & Healthcare Analytics Forum brought together payers, providers, government and academia decision-makers who shared their successes and lessons learned from their transition to value-based care. Of the many thought leaders who participated in the discussion, our client, Soyal Momin, Vice President of Data & Analytics at Presbyterian Healthcare Services (PHS), presented his abstract, “Eliminating Data Silos and Driving ROI.”
As a large integrated healthcare system consisting of eight hospitals, a statewide health plan and a growing multi-specialty medical group, PHS found it increasingly challenging to oversee its entire business from one integrated view. After investing in an enterprise data warehouse (EDW), PHS continued utilizing several reporting tools from different vendors for each of its business lines that created data silos. For PHS to thrive under the value-based care model, the organization knew they needed to balance their costs, utilization, quality, risk and outcomes. During Soyal’s presentation, he outlined how through their partnership with MedeAnalytics they could strategically differentiate themselves and add value within their integrated data analytics model. To achieve this success, PHS focused on three distinct categories:
- Creating Value for Key Stakeholders – Creating an integrated, enterprise approach, extends meaningful, actionable insights across PHS and to their business users so they’re able to access content, business rules, benchmarks, best-practice analysis and views.
- Integrating Payer and Provider Analytics – Through an enterprise approach to analytics, PHS has an integrated overview into their provider groups and health plan. The insights are extended across financial, operational and clinical areas throughout the provider-side of the organization. For the health plan, they can analyze payer data for cost and utilization.
- Promoting a Data-Driven Culture – Data literacy and data democratization is the foundation for creating a data-driven culture. A key component in creating this was tapping data analysts whose sole job is to gather data and analyze it in a meaningful way to generate results. PHS gave their analysts the appropriate training and mentoring to ensure they were developing a consultative skillset that met the needs of their diverse organization.
PHS has achieved ROI in its clinical, operational and financial areas within their enterprise. Additionally, PHS recognized operational efficiencies by replacing seven analytics vendors with MedeAnalytics, reducing redundancies and achieving quick wins with business stakeholders. More so, PHS expects to save millions in 2017 by improving collection for Medicaid encounters and increasing business development revenue.
Putting a stop to revenue cycle leaks and tracking towards MACRA goals
Performance measurement under MACRA has started in 2017, but only one-third (33 percent) of hospital-affiliated physicians have reported feeling prepared for its implementation, according to a recent Black Book Research survey. With several payment pathways to choose from, providers and their physicians have an added layer of complexity around clinical documentation, which increases their reimbursement risk. Though many providers feel strapped for time as more of their attention needs to be spent on properly categorizing claims data, analytics can help those organizations have a better grasp of their revenue cycle, especially as it ties back to value-based care goals.
Our very own Tom Schaal, director of product management, recently spoke with Jeff Lagasse at Healthcare Finance News to discuss the common revenue cycle management (RCM) challenges and opportunities as they relate to preparing for MACRA. One such challenge is the lack of time to consider revenue cycle leaks. Schaal shares three key takeaways that can help healthcare organizations have a better grasp of their revenue cycle and measurement:
- RCM shouldn’t be a second job – However, many times it feels like it. Physicians want to focus on providing the best quality care to their patients. Focusing on the minutia of RCM draws their attention away from their primary job. Technology and data can turn the RCM job into a seamless task that can be incorporated into their everyday workflow.
- Revenue leakage can happen at any stage of the care continuum – From registration to insurance verification to billing. Data analytics can help you identify where the biggest opportunity for improvement lies. Are patient no-shows causing you to lose money? Data analytics spots these trends and help you course correct the problem (i.e. set up appointment reminders for patients).
- Physician quality is the biggest opportunity for RCM – As Schaal noted in his interview, “as we look toward patient satisfaction and payment structures around things like lack of readmissions, physician quality really becomes a focal point in terms of maximizing revenue.” Ultimately, physician quality measures are going to be a “cornerstone when it comes to any enterprise's [financial] health,” and data analytics helps physicians make meaningful decisions that will impact their bottom line and future.
As MACRA moves full steam ahead, providers will need to have a good understanding of their clinical, financial and operational data to succeed. Implementing revenue cycle data analytics helps providers track towards value-based goals, while minimizing their reimbursement risk.
Want to Know How to Receive Higher Quality Scores?
In our last webinar, titled: Streamlining Your Quality Processes, our very own Bruce Carver, Associate Vice President of Payer Services, addressed the challenges and strategies needed to ensure health plans were succeeding with quality management. The healthcare landscape, especially for payers, has changed. With the introduction of MACRA and now with nearly 500,000 physicians submitting data towards it, the shift towards value is in full swing. The promotion and adoption of value-based care and the importance of quality outcomes (from NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare’s Star Ratings) has moved quality from a measurement system to an operational workflow. Payers now more than ever need to create a strong quality management program by establishing processes, leveraging data and establishing best practices to properly benchmark and track their progress.
Bruce outlined the common challenges health payers face when achieving a successful, streamlined quality management program. The challenges range from inaccessible, inaccurate data to inefficient processes and workflows. The bulk of these challenges can be alleviated with organizational processes and analytics which create checks and balances to ensure quality management programs are moving in the right direction.
Today, achieving high-quality outcomes requires an all-hands on deck, year-round effort. To work towards these programs, there are a few stepping stones that will enable health plans to implement effective processes of measurement. Here are some of the key components to quality improvement:
- Continuous, objective, and systematic process for monitoring and evaluating key indicators of care and service
- Identification of opportunities for improvement
- Development and implementation of interventions to address the identified opportunities
- Re-measurement to demonstrate effectiveness of program interventions
Data Democratization at the Heart of Health Datapalooza 2017
The 8th Annual Health Datapalooza conference in Washington D.C. brought together a variety of data advocates who focused on how to harness the power of big data and put it into the hands of the people who benefit from it most: patients and providers. As part of the two-day event, one of our clients – Ian Morris, Clinical Data Interoperability Project Manager for the State of Mississippi, Division of Medicaid – presented as part of a panel titled “Health Systems Reaching Out to Patients and Providers.” During his presentation, Morris shared Medicaid’s experience of modernizing their Medicaid infrastructure and empowering real-time data sharing across all of Mississippi. In addition, Morris outlined lessons learned around interoperability and the roadmap for Medicaid’s interoperability efforts in years to come.
After the conference came to an end, we connected with Morris to discuss his experience at the event and other key takeaways. Morris shares his highlights below.
1. As a first-time attendee and presenter at Health Datapalooza, what intrigued you most about the event?
It was refreshing to hear the patient perspective. A lot of the time when you attend conferences that focus on data and analytics, you don’t get the rich patient narrative. However, Health Datapalooza took the imperative to put democratization of health data at the heart of the event. Empowering the physician and patient to take control of the data is what we’re all striving for, and that’s where organizations like Medicaid fit into the narrative. You need to understand the value of data first, and that’s where we – people such as interoperability managers – come into play. We translate that value, and once it’s understood by the provider, it can be shared externally with the patient.
2. What was a best practice that you learned from your peers and what do you hope to see at next year’s conference?
There were many presentations at the event that delved into the importance of collaborating between multiple state systems (i.e. bridging the broader health and human services, mental health and advocacy groups together) all for the greater good – improving patient outcomes via better data sharing. Such intricate collaboration efforts made me think of the initiatives Medicaid plans to embark on in the future. If there is one take away, it’s that statewide collaboration is key to better data sharing practices. My hope for next year’s conference is to have more speaking panels that touch upon just this, especially as it relates to interoperability efforts overall.
3. Other post-conference highlights that you’d like to share?
Health Datapalooza was full of energetic and enthusiastic data leaders. From patient advocates, to vendors to hands-on project managers, conference attendees and speakers embraced each other’s lessons and shared challenges of their own. Serving as a microcosm of what we’re all striving for in healthcare, Health Datapalooza reminds us that the sharing and analysis of data has a purpose – and that is ultimately to improve patient outcomes.
To read more about how Mississippi Division of Medicaid became the first Medicaid Agency to exchange clinical data summaries with their providers, read their story here. To learn more about how to act on your data and ensure quality, cost-effective care for Medicaid beneficiaries, visit our Provider Access solution here.
Best Practices for Providers Looking to Improve the Quality of Care
In all areas of healthcare, organizations are looking for innovative ways to reduce costs and improve quality. According to a new study published in Health Affairs, MACRA could reduce CMS physician services spending from $35 billion to $106 billion. MACRA is also leading the way towards quality healthcare by creating incentives and penalties for providers who leverage the program to improve quality and efficiency of care. For providers to succeed under MACRA, they must work collaboratively with payers to meet the quality objectives defined by CMS.
In order to qualify for incentives and avoid penalties under MACRA, providers have the option to choose from two payment models: MIPS and APMs. Under MIPs, providers’ performance on quality, EHR use and practice improvements will be measured this year to determine the incentives or penalties they will receive in 2019. CMS is expected to notify physicians who are eligible for the program by the end of the month. APMs give incentive payments to providers that offer high-quality and cost-efficient care and can apply to a specific clinical condition, a care episode or population.
This week, our blog shares three steps providers can take to help ensure they are successfully meeting the requirements under these programs:
- Ensure Access to the Correct Tools - In a recent blog post, John Hansel, vice president of provider solutions, notes, “CMS’ quality reporting is complicated. There are numerous requirements that providers need to meet – from patient satisfaction to Electronic Health Record reporting – which can be difficult to manage. To ensure healthcare organizations are on track with these measurements, they need to have the right tools and insights in place to meet CMS’ various measures.” As providers look to improve quality and find success with the ever-evolving quality measures, they must ensure they have the correct tools in place to find success in improving patient care.
- Work with Payers to Break Down Data Silos - Although there has been some improvement in breaking down data silos, data preparation still accounts for nearly 80% of the work included in acquiring and preparing data. This can prevent the health system from getting a holistic look at the total patient record. To steer away from these data silos, providers need to leverage their relationship with payers, who typically are the only entity that have the data required to create a holistic patient record. Payers can provide access to crucial information, including the care received when the patient goes out of network. Overall, the shift to VBC requires that payers and providers work together in this aspect.
- Adopt Technologies Aimed at Improving Quality Measures - To truly succeed in improving the quality of care for the patient, providers must adopt technologies that serve as a basis for their collaboration efforts with payers. These programs must be able to successfully measure and monitor quality measures and create data driven conversations so payers and providers are aware of how to best improve quality for their populations. MedeAnalytics’ quality management solution offer insights that enable health plans to fully understand performance on quality measures and ultimately improve quality care for members.
At the end of the day, providers should be aiming for one goal: to improve patient care. To successfully provide patients with the best care possible, providers must work with the right tools, successfully leverage payer data and adopt technologies that serve as a place for collaboration with payer partners.
For more on how your organization can best improve the quality of care for your members, access our whitepaper, Enabling Payer and Provider Collaboration in the Journey Toward Quality Care. To find out how MedeAnalytics can act as a strategic partner in this journey, learn about our quality management solution here.