CHIME Series: Are Self-Insured Providers the Future of Healthcare?
As healthcare’s future continues to be battled on The Hill, we recently conducted a College of Healthcare Information Management Executives (CHIME) survey that outlined several questions around the various data-challenges facing healthcare organizations in the transition to value. This week’s blog focuses on the survey question: With the shift to value-based care, has your health system considered becoming or adopting parts of an integrated healthcare system (i.e., becoming a provider and a payer)? The results show that more than half (61.7 percent) of respondents have considered moving towards this model. As the U.S. healthcare spend continues to rise, with average healthcare costs close to $10,000 and the national level equaling more than 3 trillion, the need to better manage expenses is a top priority. One way to do this is through the cohesion of payers and providers, along with the use of data analytics as a guiding light.
At MedeAnalytics, we’ve worked with two healthcare organizations who have created an integrated healthcare system and utilized their valuable data resources to create analytics platforms that break down barriers and lead to lower costs and higher quality care.
Covenant Health: Covenant Health (Covenant), a self-insured hospital, uses data analytics to adopt an innovative approach to population health to drive down costs and engage in preventative care initiatives. Using a data analytics approach they achieved the following:
- Identified healthcare utilization to improve care for employees and their families
- Designed benefit plans
- Reduced overall health spend
By drawing insights from population health data, they strategically identified at-risk patients and proactively managed their care. Covenant determined that employee healthcare costs were more than 10 percent higher than the general population. Overall, just 9 percent of the highest risk employees were found to be responsible for 40 percent of employee health plan costs. The insights found in the data enabled them to proactively manage their employee population to identify exactly where money was being spent.
Presbyterian Healthcare Services: Presbyterian Healthcare Services (PHS), is an integrated healthcare provider and payer organization, looking to improve quality and reduce costs. Using data analytics, they strategically differentiated themselves and have added value within their integrated model. To achieve their success, PHS focused on three distinct categories:
- Created Value for Key Stakeholders
- Integrated Payer and Provider Analytics
- Promoted a Data-Driven Culture
PHS 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.
To learn more about Covenant’s success, check out their case study here. For insights on PHS’ journey with data analytics, click here. If you’re looking for ways to become an integrated system or want to learn more, reach out to us: http://medeanalytics.com/company/contact.
Looking Ahead: Analytics for Tomorrow’s Healthcare Economy
While there’s still a lot of uncertainty in the healthcare atmosphere, tracking towards value-based care (VBC) will remain an unchanged goal, according to Rick Pollack, president and CEO of the American Hospital Association who spoke at the 18th Annual Citi Not-for-Profit Health Care Investor Conference. Healthcare organizations that are cognizant of this journey to value are beginning to invest more in data analytics to help support them. In fact, by 2021 the healthcare analytics market is projected to reach $24.55 billion according to a Research and Markets report.
With the continued focus on value, it’s no surprise that at the recent HFMA ANI conference, many speakers on the agenda addressed just that, as well as highlighted the role data and analytics will play. In fact our very own customer, Wise Health System presented on their revenue cycle and compliance analytics partnership. Beyond the fruitful insights provided from the show, we’ve outlined three general themes that are resonating in the healthcare market:
- The steps to value – At HFMA ANI topics ranged from finding the path to value to simply growing your value. The topics – like providers’ readiness for the transition– vary widely. According to a HealthLeaders Survey, providers are still in the very early stages of the transition. If they haven’t begun the transition already, the time to start is now. The journey may seem arduous, but with the help of analytics tools, providers can understand where they stand in the process and how best to prepare for the steps ahead.
- Reimbursement under value – Providers will need to implement supporting payment programs. In a recent blog post, we outlined how providers feel unprepared for the implementation of programs like MACRA, citing time and complexity as the top concerns. Similarly, some providers may find themselves unaware of the other payment options available. For example, the often-forgotten MIPS-APM track helps physicians shift to VBC without taking on too much financial risk – but this track isn’t as well known, and thus not as frequently utilized. To succeed under value initiatives, providers ultimately need a good understanding of their clinical, financial and operational data. Revenue cycle data analytics helps providers understand these areas, all while minimizing their reimbursement risk.
- Approaching value holistically, not piece-meal – Take for example quality improvement programs. Hospitals implement these programs hoping to reduce their hospital readmission rates, and in turn save money. However, just implementing one quality program isn’t enough. A new study from the Journal of the American Medical Association shows that quality improvement programs don’t necessarily translate into big financial savings. Providers need to see the entire picture of their organization to pinpoint where revenue improvement opportunities lay. Implementing analytics can help organizations figure out if they’re on track to overall financial value, or not.
Regardless of the changes and the in-flux state of healthcare now, tracking towards value-based care will remain a constant initiative. Providers must have a holistic view of their enterprise to figure out where they can mitigate risk and optimize value. To learn more about the analytics tools that can support you in your transition to value-based care, visit our solutions page here. If you are interested in learning about additional ways to amplify your analytics journey check out our latest white paper here.
Meet MedeAnalytics’ new CEO, Paul Kaiser
Last month, Paul Kaiser was appointed as the new CEO. In his first few weeks, he focused on meeting with our teams and clients. We caught up with Paul to hear more about his background, what he’s observed so far and what he hopes to accomplish in the year ahead:
Can you share more details about your experiences prior to Mede?
Over the past 14 years, I’ve held several roles on the provider (Cerner), payer (TriZetto) and middle (TriZetto Provider Solutions) sides of healthcare. This afforded me a unique first-hand view of the healthcare value-chain, and where that chain diverges and converges. Having both perspectives is enormously important in a market where these sides come together to administer better healthcare in a value-based reimbursement market. Mede has long served both markets so I’m thrilled that I get to share my experience as well.
In the first month that you’ve been at Mede, what have you seen and what are you most excited about?
The commitment of our team is unparalleled. The desire to make a difference and contribute to our client’s success is nothing like I’ve ever seen. This is what makes Mede a truly exciting place. When you combine really smart people with a commitment to make a difference, the possibilities are endless.
It has also been incredible to see and hear about the immense value we’re driving for our clients. The feedback about our technology, the business impacts we are having within our client’s organizations and the future vision for how they will be using MedeAnalytics to create analytics-driven culture change is overwhelmingly positive. We have an incredible client base. It’s very exciting to see the value in the data we’re providing clients and how that is helping them cross the chasm to performance-based management cultures.
Finally, the product and technology teams’ work to develop a world-class big data platform is amazing. The amount of data we process and turn into value-driving data visualizations and actionable workflow is incredible. To be at a company capable of making such material contributions to our clients’ success is energizing.
What do you see as the biggest opportunity for Mede clients?
From my years seeing both the provider and payer perspectives, it is clear to me that very few organizations are driving their businesses and operations from an enterprise, data-driven level. For example, you often see C-suite leadership in a hospital or health system establish a vision for the enterprise and from that direction, teams will create initiatives designed to achieve those goals. But once goals are established, there is little real-time intervention or progress monitoring. This means that organizations typically don’t realize something is off-course until the reporting phase. However, if an organization can tie data analytics from across the enterprise together, it can observe and influence results in real-time, allowing the organization to course-correct and deliver on initiatives from the department to the individual level. Data-driven performance management is the only route to optimal success in today’s market.
What are Mede’s top priorities in the coming year?
We work with the largest healthcare solution providers and health systems in the country, and they are depending on us. We need to be stellar and deliver on our commitments.
We also want to ensure scalability and stability for our clients via our platform. As we look towards Mede’s next phase, our focus will be to continue delivering a high-performing technology platform that can scale in the market. We also want to enable client-led innovation by extending configuration and integration layers to our clients as well as third-party certified business partners.
How do you see MedeAnalytics growing and/or evolving to support clients amidst an everchanging healthcare landscape?
Change is the one constant in healthcare. Whether it is through government or regulatory shifts, moving away from fee-for-service to alternative payment models or performance-based reporting with MACRA and MIPS, change is certain. Whenever an organization tries to respond to change and create new business strategies, it needs data and analytics to make smart decisions. Organizations also need to be more performance oriented to optimize health outcomes based on real data. Mede can be a part of that. Regardless of whether the government decides to keep the Affordable Care Act in place or implement some other version, from a data analytics perspective, we are in a great positon to support our clients with the tools to be nimble and make strong, smart, data-driven decisions.
Why CFOs and CIOs Need to Collaborate at HFMA ANI
The upcoming HFMA ANI conference (June 25-27) in Orlando, FL, will bring together thought leaders in the healthcare finance space to connect, discuss and explore the opportunities ahead. This year’s show theme – collaborating for the future – is particularly timely since the healthcare industry continues to rapidly consolidate, and the fate of the Affordable Care Act still hangs in the balance. The Trump administration’s potential new healthcare bill increases the likelihood that there will be a rise in uninsured patients, high-deductible plans and a continued focus on cost-cutting and value-based reimbursement for healthcare providers.
The lack of clarity and fast-paced changes in the market places even more pressure on Chief Financial Officers (CFO), whom are already challenged with juggling the transition to value-based care while managing fee-for-service (FFS). In addition to these pressures, many CFO’s feel like their issues are often de-prioritized in the long list of tech projects led by Chief Information Officers (CIO), who are more focused on clinical initiatives. With so much technical effort and budgets directed toward clinical transformations and electronic medical record (EMR) installations over the past 10 years, the financial analytics tools required to thrive under payment reform have been neglected.
Building a better community through better health with Mede/ACTS
Interest in employee-sponsored volunteering programs is on the rise. According to a 2016 National Study on Satisfaction at Work, employees are drawn to employers who support charitable causes and community volunteering. In turn, employers are recognizing their role in spearheading philanthropic efforts. We recently connected with our very own Eric Roth, VP of Human Resources, to hear how MedeAnalytics approaches volunteerism in the workplace.
As a company dedicated to promoting employee wellness, MedeAnalytics launched Mede/ACTS in 2016, an initiative that helps give back to local, charitable organizations. Building off a previously existing wellness program, Mede/ACTS combines physical and community wellness into one. The premise is simple, but powerful: for each physical activity Mede employee’s complete – whether it’s yoga, biking, or kickboxing – senior leadership matches their efforts by contributing $1 for every 10,000 steps and for every 60 minutes of exercise that has been logged into wearables, fitness apps and FitBliss, a health & wellness technology platform available to all Mede employees. All the raised funds are donated to the charity of Mede/ACTS’ choice. Each quarter the charity varies; the Mede/ACTS committee selects charities that are nominated by Mede employees.