With or Without ACA, Payers Should Continue to Invest in Analytics Capabilities
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.
Insurers and Healthcare Providers Find Common Ground in Population Health Data
Earlier this month, I spoke with Henry Powderly, Editor-in-Chief of Healthcare Finance News to discuss the major shift in the healthcare industry with population health management. Henry and I focused on the growing payer and provider collaboration and how MedeAnalytics is adapting to meet the needs of our customers. Here are a few key takeaways from our conversation:
“While payer-provider collaboration has long been important, new trends in managing population health data is strengthening that relationship as never before, and in many ways it's changing how providers think.
A growing number of payer clients are leveraging the exact same data, but they're asking questions in a different way, adding that the company has seen more insurers sign on as clients recently.
Data Analytics to Improve Medicaid Care and Costs
As the healthcare industry shifts to value-based care and fine-tunes their efforts to lower unnecessary costs, Medicaid state agencies have looked to major players in the healthcare data analytics space. This leap is of course not easy for many of these state entities but the Mississippi Division of Medicaid (Mississippi DOM) offers a shining example of how to successfully leverage data analytics to improve care while reducing costs. Several other state Medicaid agencies have already tapped on Mississippi DOM for insights and best practices for adopting a similar initiative. I predict that we’ll see many other states making the leap into big data in 2015 to align their payments with quality and value.
Boost Data Transparency with APCDs
All-payer claims databases (APCDs) would benefit from mapping morbidity rates to the data resulting in pricing transparency, as well as pricing, efficiency and performance assessments that can be compared among providers. Mapping morbidity rates using publicly available data would create a clear idea of healthcare effectiveness and enrich the data, enabling patterns of care and value to emerge and in result, improve the future of healthcare. Here's a preview of Virginia Long and David Mould's piece on iHealthBeat that went live today: