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.
How are you Tracking to Value-Based Care?
It’s no secret that today’s healthcare landscape is changing. As costs rise and reimbursement models change, healthcare organizations are continuing to track towards value instead of volume. With this transition comes the rising importance of quality, especially since payers and providers are now dependent on quality measures for reimbursement. According to CMS, these measures are meant to quantify healthcare processes, outcomes, patient perceptions and organizations’ structure associated with providing high-quality care. This journey requires a shift in mindset and new approaches to sharing information to enable quality improvements.
The first step in improving quality of care is the collaboration between payers and providers. Bruce Carver, associate vice president of payer services at MedeAnalytics, notes the importance of this collaboration in a recent interview with Becker’s Hospital Review, explaining that there are great opportunities between payers and providers, especially around data and best practices, to enhance value-based care, such as eliminating gaps in care and driving positive outcomes.
The second step is to use data as a guide to outline areas of opportunities. As payers and providers adopt technologies that enable value-based care, forward thinking organizations are collaborating on quality management programs that serve as the basis of their efforts. These programs must be designed to not only measure and monitor quality measures, but also lead data-driven conversations so payers and providers can collaboratively improve clinical outcomes for their patient populations. Through collaboration and the power of data, both payers and providers can leverage valuable information in the following ways:
- To measure and record an organization’s performance – Both payers and providers can benefit from understanding where their organization is succeeding in providing their members and patients with quality care. Among the many measures, HEDIS and CMS Star Ratings have the greatest impact as value-based care unfolds.
- To help avoid duplicative care – Today’s disconnected provider environment means that many providers operate in silos and do not have insight into care performed by other providers. Duplicative care is not only a waste of time for the patient, but it also negatively affects the healthcare organizations’ bottom line. By taking a holistic approach to a data strategy, organizations can better work together to avoid this.
- To better identify high-risk patients – Data, combined with population health tools and predictive analytics can identify high-risk patients immediately instead of waiting months for data to be generated. Identifying these types of patients early can allow organizations to step in to create personalized, automated interventions that lower healthcare costs and improve the overall health of the patient.
As healthcare industry continues to evolve, payers and providers must look toward a future defined by positive outcomes for their patient populations. The focus on quality and value will become more deeply ingrained. To meet these objectives, organizations must collaboratively design programs that enable them to meet or exceed quality measures and pay-for-performance expectations—today and for years to come.
To learn more about how to improve quality of care for your members in today’s changing healthcare ecosystem, access our whitepaper, Enabling Payer and Provider Collaboration in the Journey Toward Quality Care. To learn how MedeAnalytics can help you on this journey, learn about our quality management solution here.
Enterprise Analytics and Beyond: A Q&A with our Vice President of Healthcare Provider Solutions
In a previous blog, we explored the important approaches and best practices that the payer industry needs to keep in mind to succeed amidst a climate of uncertainty. For this week’s blog post, we are exploring top provider concerns in a conversation with John Hansel, our vice president of healthcare provider solutions. During a Q&A, John shared his perspectives on the challenges that lay ahead for providers and the continued importance of investing in Enterprise Analytics (EA) strategies in today’s rapidly changing healthcare environment.
1. Major healthcare industry transformations will happen in 2017 but what will remain constant? And how can an EA strategy help organizations prepare?
Collaboration between payers and providers will be important regardless of any potential repeal and replace of the Affordable Care Act (ACA). Since the ACA passage, providers have assumed more risk which has led them to acquiring or establishing health plans to help manage and ease the financial burden. In fact, PriceWaterhouse Coopers estimates that 50 percent of health systems have applied or intend to apply for an insurance license. With healthcare organizations establishing their own health plans, they will need to continue to invest in robust analytics to properly manage insight. This collaboration creates more data as information flows in from payers, providers and patients. More data means more information to sift through, making it even more challenging to turn that information into action. The investment in analytics will thus remain a top priority as the technology can offer providers a holistic view of financial, clinical and operational data that fuel cost-saving decisions. This holistic approach to data will help providers better manage the risk they are taking on and gauge areas for improvement whether it be gaps in care or medication adherence.
2. To succeed with an EA strategy, healthcare organizations need to integrate analytics and data into everyone’s day-to-day. How is this done?
There are many challenges that arise when establishing any type of analytics strategy – from a lack of leadership, proper IT support and the associated cost. Some of this is out of our control. However, there are proactive approaches that can be taken to ensure a seamless EA strategy:
- Train and educate the clinical leadership – Healthcare organizations need to invest in their people and training. For example, clinicians often don’t have the background or bandwidth to tackle analytical insights without guidance and support. As such, clinical leaders would benefit from educational courses, workflow conversations and other prep to ensure that they can direct their clinical teams in a data-driven manner.
- Establish realistic goals – Training and education investments are doomed to fail if a provider executive doesn’t establish realistic goals. To ensure that data-driven leadership and approaches become part of a clinical staff’s day-to-day, set realistic goals and timelines. And be patient – this will be an iterative approach vs. a one and done.
- Empower self-service - Putting the tools in the hands of business decision makers can ensure real-time decisions are being made towards important organizational goals. There are various tools and interfaces that business leaders can be trained on that are geared with business end-users in mind. This ensures that insights are getting delivered and implemented throughout the healthcare organization and not in an IT-bottleneck.
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.