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 an Enterprise Analytics Strategy
The healthcare economy is changing rapidly – from increased consolidation to the rise of consumerism in care, healthcare organizations face a market that requires a holistic understanding of their enterprise (from clinical to claims data) to succeed. To stay competitive and deliver the best quality of care and value, providers should think like payers and payers like providers. As such, strengthening integrated care remains a hurdle for organizations to overcome as they seek to improve clinical quality, reduce operational costs and support care management. To achieve these goals, healthcare systems must be able to have access to data not just within their own organization, but from outside sources – which is often siloed.
A HFMA Health Care 2020 report on consolidation points out that to succeed in an increasingly competitive marketplace, healthcare organizations are investing in data analytics capabilities to help them understand their patient – and entire business – better. While investing in analytics is an integral key to success, an overall best-practice strategy must be developed to make data actionable. Here are five best practices that should be adopted to initiate an analytics strategy:
- Identify enterprise champions – To ensure buy-in from key internal stakeholders, leadership and process changes must occur. Change to the entire organization’s attitude on data governance must come from the top and trickle down to the bottom.
- Find value in existing data – As new payment models are adopted, healthcare providers need to design a technical infrastructure that can integrate payer, health system and medical group data within an enterprise healthcare delivery system to create value. Organizations should leverage their core data set and claims data, but also pull in existing ancillary data to have a better understanding of their organization.
- Create data-driven culture – Establishing an enterprise analytics department ensures that the entire business is standardizing and handling data consistently, but also encourages the new analytics department to champion a holistic approach towards data management. Champions should include representatives across all departments, from clinical to claims teams.
- Outline and developing manageable goals – Instead of tackling all problems at once, start small. Is the organization focusing on obtaining a streamline, single view of their entire business? By setting a goal with real, manageable next steps, all stakeholders can quickly perceive value in an enterprise initiative.
- Train, train, train – Repeated trainings and regular communications across the enterprise ensure long-term initiative success. By holding teams accountable, while empowering them with resources to succeed, data sharing efforts across the enterprise are bound to improve.
Changing goals and evolving organizational structures require players in the healthcare industry to pivot quickly. Whether it’s to meet increasing consumer demands or to better align on value-based initiatives, organizations will need to rely even more on data to achieve their goals. When organizations embrace analytics, and have a go-to data analytics strategy, the procurement and actionable next steps will come naturally.
To learn more on how to take action with your data, 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.
Springing into Spring: Health IT Trends to Look For
After a long, cold, winter, the melting snow and warmer weather means spring is finally here. The health IT industry has been busy this past winter with the HIMSS17 conference and the stalling of the GOP health care bill, to name a few. At HIMSS, healthcare leaders were busy discussing machine learning, analytics and population health and sharing new technologies aimed at improving patient care. After the GOP healthcare bill was pulled amid widespread reports that they did not have enough votes to pass it, Republicans say repealing the ACA is back on the agenda, adding to the uncertainty that has faced the industry under the new administration. To kick off the new season, here are a few of the trends that we are keeping an eye out for:
- Precision Medicine – Despite concerns regarding the overall effectiveness of interoperability and big data, a survey by NEJM Catalyst Insights Report found that precision medicine data will have a major influence on the industry in the coming years. This new approach to treatment will be used to eliminate medication errors, improve care, treat disease and help provide feedback for physicians.
- Leveraging Big Data to Solve Population Health Issues - The future of healthcare lies in data but its application is constantly shifting. With the data generated from EHRs and wearables, organizations are faced with growing amounts of useful insight, that in many cases will go unleveraged due to silos or a lack of analytics tools. Throughout the winter, we saw how communities are leveraging data to tackle the opioid crisis, pathologists are using it to detect breast cancer and providers are using it to reduce waste. We will be keeping an eye out to see how organizations will continue to leverage big data to draw insights and uncover new tools.
Finding success in the changing healthcare landscape: Q&A on MedeAnalytics’ Consulting Services
With uncertainty surrounding the ACA and the new administration, payers and providers alike are facing many challenges. Payers are bracing themselves for the 20 million people who could become uninsured, 20 percent of providers remain unfamiliar with the requirements set in place by MACRA and 35 percent of providers are still not getting paid via alternative payment models. These challenges, in addition to any potential roadblocks from new policies, mean that the industry needs to have a strong understanding of where they stand in their journey to value and the potential risk they can feasibly take on. To understand this, healthcare organizations need a strategic partner that can provide best-in-class analytics and guidance on how to make the most of their analytics investment. MedeAnalytics’ consulting team helps clients across the nation better leverage their data and turn cost-saving opportunities into realities.
In this week’s blog post, we explored the current client landscape with Karen Mitchell, Group Vice President of Consulting Services. This Q&A highlights how MedeAnalytics’ consulting services are helping clients overcome their challenges to remain successful in the competitive healthcare landscape, along with her predictions and hopes for the industry throughout 2017.
1. What are some of the common challenges that healthcare organizations come to you with, especially with the uncertainty around the ACA?
Due to rising costs, the continued transition to value-based care and new CMS regulations, financial risks are greater today than they ever have been. Provider organizations are looking for insight into how they can accurately and appropriately bill to decrease denials, improve payment accuracy and ultimately increase revenue and cut costs. Our consulting services can help organizations better identify ways to manage their financial risk so they don’t inadvertently miss revenue opportunities or receive less reimbursement than contracts stipulate.
Payers are facing similar issues due to variations in the cost of services from hospital to hospital. For example, knee and hip replacements are very common operations in the U.S. with about 1 million done each year. In most cases, health plans are not incentivizing members to go to hospitals with lower costs and higher quality outcomes, putting millions of dollars on the line in potential losses from high-cost, lower-performance hospitals. We can help payers identify high-performing hospitals and collaborate on strategies that encourage members to use these top providers, all of which can generate major savings for all.