Payer and Provider Collaboration Ensures the Industry is Tracking Towards Value
Collaboration between payers and providers is an important asset to improving quality of care across the healthcare ecosystem, while simultaneously keeping costs down. For example, payers have access to a significant number of claims data that creates a holistic view of patients’ information, while providers typically have discrete clinical data information. By working together to exchange this information, payers and providers can stay on top of patients and ensure they are getting quality care and avoiding high-cost events, such as visits to the emergency room. Also, with value-based care top of mind, payers and providers need to work together to leverage data and analytics to reach that end goal. We talked to Bruce Carver, Associate Vice President of payer services at MedeAnalytics, for his insight on the current challenges that prevent payer-provider collaboration, best practices to achieve it and why it’s useful.
Challenges that can arise within collaboration
When it comes to payers exchanging information with providers, storing clinical data received from an electronic medical record (EMR) is very expensive. There is no standard format across the U.S. for providers to implement that information simultaneously. Oftentimes, payers don’t want to add another system to store that information, instead integrating it through an EMR that can be sent out from a provider’s system and to a payer. In addition, providers have access to more timely data as well, enabling immediate outreach to patients. Ultimately, collaboration is needed so both the payer and provider are on the same page when it comes to treating patients. If either doesn’t have the complete information, it can result in gaps in care and ineffective treatment.
How analytics can help
Analytics can provide additional ways that a provider and payer can exchange that clinical information. In an EMR, there are hundreds of different measures and metrics that are collected within that provider’s system but oftentimes only a small portion of that is necessary to be able to collaborate effectively for the value-based programs that are in place. MedeAnalytics has enabled external use of its platform by a provider to be able to attach and upload that information straight into an analytic tool that is used to measure results of the program, which makes for a more cost-effective solution.
Finding Success with Big Data Analytics in Healthcare
The healthcare industry is in a state of flux, but one thing that remains constant is the focus on cost and quality. To achieve success in value-based care, healthcare organizations need to invest in the right tools. In fact, a recent study found that 70 percent of healthcare leaders believe health IT tools are essential for growth.
MedeAnalytics client Soyal Momin, vice president of data and analytics of Presbyterian Health Services (PHS), recently connected with Jennifer Bresnick of HealthIT Analytics during HIMSS18. They discussed the challenges of balancing cost and quality, and Momin outlined a step-by-step plan that helps his organization make the best use of their data and analytics investment.
Momin noted that PHS found it increasingly difficult to oversee its entire business—eight hospitals, a statewide health plan and a growing multi-specialty group—from one integrated view. Balancing the organization’s costs, utilization, quality, risk and outcomes became a challenge. But by following the step-by-step plan, PHS achieved measurable ROI in all clinical, operational and financial areas of their enterprise while reducing redundancies and achieving quick wins. By extending analytics across the enterprise and eliminating point solutions, PHS saved more than $11 million.
CHIME Series: Are you making the most out of payer data?
This week, we continue to explore the results of our College of Healthcare Information Management Executives (CHIME) survey and the need for various data sources. Our survey asked the question: Do you have a strong grasp on how to deal with payer data today? The results show that the majority (57 percent) of provider organizations do not.
As healthcare costs continue to rise and the industry focuses on value-based care, payers and providers need to look for ways to collaborate. This relationship is critical to payers as they leverage EHR data to better understand the cost of services rendered by the providers, measured against the outcome of care. For providers, combining both claims and clinical data can reveal some extremely valuable insights that can positively influence clinical decisions and drive down costs. However, many organizations still face challenges, including a lack of appropriate tools and an influx of data that is difficult to manage. This then creates a lag in insights being delivered to the right people at the right time. Bruce Carver, associate vice president of payer services, believes optimized organizational coordination can help address some of these issues.
Here are two of his best practices for making the most out of payer-provider collaboration:
- Trust Each Other– The first step in any relationship is trust. Are your goals aligned? Do you have redundant reporting or processes to get to these shared goals? Where can things be streamlined? This relationship will take time as both parties must work together to improve collaboration and ultimately gain more insights.
- Establish Communication Processes – Communication is also key and establishing efficient processes can help ensure that organizations are on the same page when issues arise. Some of these issues include, gaps in payer data or instances when payer data is not directly aligned with provider data.
Once organizations are aligned, payer data can be leveraged to better meet industry-wide demands of becoming more patient-centric and value-driven. This collaboration can also help providers manage medication adherence and establish cohesive strategies that address this issue.
As providers continue to struggle with a lack of organizational resources and payers begin to shrink in numbers, payer and provider collaboration will be more important than ever. Additionally, creating this collaboration can help both parties ensure that they are on the right track towards value. To see more results from our CHIME survey, access recent blogs here and here. If we can help get your organization on the right track, make sure to contact us.
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.