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.
How Covenant Health Utilized Analytics towards Population Health
Despite the initial administrative concerns, the healthcare industry is continuing its journey towards value to curb costs and improve patient outcomes. The U.S. healthcare spending, which in 2015 hit nearly $10,000 for every person in the country, is 29 percent higher than the next most expensive country, Luxembourg. With rising costs, the industry is looking towards innovative programs that tap healthcare organizations biggest resource: data.
Both Richard Boehler, MD, president and CEO, and Rebecca Williams, RN, care coordination manager at St. Joseph Hospital of Covenant Health (Covenant) connected with Bill Siwicki of Healthcare IT News to discuss how Covenant tapped their timely information to curb costs and improve quality of care for their employees. Here’s a recap of the key takeaways from the discussion:
- Adopted a population health program – To better track and manage the health of Covenant employees across three hospitals and affiliated facilities they looked to population health as a solution. By operating as a self-insured entity, Covenant saw this move as a necessity to improve health and control increasing expenses. The goal of the program was to enhance the well-being of employees, decrease costs and better understand the healthcare utilization patterns of employees and their dependents.
- Harnessed data analytics – Through data and analytics, they guided their population health management efforts. “The first thing we started thinking about was where the money was going; it must be avoidable ER use. We dug into the data, and nope, that wasn’t the case. Then we thought back injuries, so let’s dig in there and maybe we could create a comprehensive back program. But it wasn’t even our employees, it was their spouses, so that went out the window,” said Williams. Executives and caregivers learned that they had to prioritize their employees in terms of healthcare consumption.
- Making insights actionable – “You cannot take a population and put a stamp on it and say let’s do things this way; we had to look at prioritizing people and we worked with sophisticated analytics to see where our time would be best spent,” Williams explained. “The high utilizers were on dialysis or had an organ transplant or an acute burn, those were not things we could make an impact on. But that middle 70 percent is where we could make an impact. Keep people in the middle 70 percent from moving up to the highest spend category.”
Through Covenant’s efforts, they could identify cost drivers and opportunities for preventative care, enabling one of their three facilities, St. Joseph Hospital, to spend $2.5 million less in 2016 and a 12 percent per member per month improvement over all of 2015.
For more insights on how Covenant created a successful population health program, check out the full Healthcare IT News article or their case study here. If you’re interested in learning more on how our population health solution can help your organization – check out details here.
Case Study: How St. Joseph Hospital Achieved 12% Savings with Population Health Data
Due to rising healthcare costs and the shift to value-based care, many organizations are now looking to improve quality and reduce costs. In our recent case study, we highlight how St. Joseph Hospital, part of Covenant Health, was able to leverage our population health solution and consulting services to adopt an innovative approach to population health within its workforce, reducing per member per month (PMPM) costs by 12 percent and saving nearly $2.5 million in 2016.
Prior to MedeAnalytics, St. Joseph Hospital was unable to draw insights from its data. The health system wanted a solution that would allow them to reduce costs, while also improving the health and wellness of their employees.
Through our partnership, St. Joseph Hospital was able to identify which employee patient groups were at risk for chronic conditions and high-cost care. For example, they discovered that a high percentage of pharmacy spending came from specialty drugs and were able to save at least $100,000 with generic drug substitutions. The partnership also allowed the hospital to achieve the following:
- Reduce one employee’s $700 monthly prescription costs to $9
- Build a foundation for population health initiatives
- Devise a focused plan design around data insights
These accomplishments have established a building block for the healthcare organization to continue its march towards value-based care. “We see this as an important stepping stone towards our goal of having at least 50 percent of our payments being tied to value-based models by 2018,” says Richard Boehler, MD and CEO of St. Joseph Hospital.
Taking a Look Back - Our Top Webinars From 2016
At MedeAnalytics, we pride ourselves on acting as a resource for the health IT community. From case studies to webinars, we strive to provide our customers and the overall industry with the information they need to excel in the changing healthcare landscape. As we enter 2017, we are taking a look back and counting down our top three webinars from 2016.
3.) In third place is ICD-10 Analytics, which offered an overview on how to leverage data from peer organizations to execute CDI strategies. The webinar included insight from Trevor Snow and Adrienne Younger of Ardent Health Services. They both shared Ardent’s success story and explained how they were able to use our Revenue Integrity solution to identify documentation trends, pinpoint and address coding issues and more.
2.) In second place is Value-Based Contracting: Ease the Transition to Accountable Care. The November webinar highlighted how St. Joseph Hospital, part of Covenant Health, was able to use our Population Health solution to reduce their employee health plan costs in the first eight months of 2016. It also identified best practices that organizations can follow to efficiently transition to VBC.
1.) In first place is, Get Big Picture Insight into Your Revenue Cycle, which demonstrated how to leverage analytics to gain insight into the revenue cycle. The webinar highlighted how our customer, West Tennessee Healthcare, took control of their financial operations to improve AR days, reduce bad debt, understand denial root causes and more.
As we march forward into the New Year, we are excited to continue on as a go-to resource for the health IT community. Make sure to check back weekly for new blogs on pressing healthcare issues and the latest news from MedeAnalytics.
Population Health is Here, But More Needed in 2017
With 2017 right around the corner, MedeAnalytics is looking ahead to see what’s on the healthcare horizon. From now into the New Year, we will be focusing on the evolution of the industry – from value-based care to data.
Population health management is not a new concept for any healthcare provider. In fact, a Deloitte study predicted that having advanced analytics capabilities to improve population health initiatives was a top priority for providers in 2016. To succeed, more providers will need to adopt this initiative in a value-based care world.
We connected with Christian Wieland, vice president of product management at MedeAnalytics, to get his take on the key aspects to watch in 2017 as they relate to population health and the transition to value-based care.
1.) How important have population health initiatives been within healthcare organizations in 2016?
The simple answer: very important. In 2016, we saw population health initiatives become increasingly important and mainstream. Accountable Care Organizations, Bundled Payments, Pay-For Performance and Value Based purchasing are just a few of the many initiatives providers are now participating in within the population health domain that is increasingly its fiscal implications. With the shift towards both delivery reform and payment reform, population health has spread to providers as well, but initially only through the more progressive institutions.