Healthcare Data is Growing, But Are Health Plans Making the Most of It?
According to a report from Dell EMC, healthcare data is growing astronomically, at a rate of 48 percent per year. In today’s healthcare economy, payers are looking to leverage that data to provide better service, more customized plans, and improved care for their members. Data analytics enable payers to harness data insights to bring better focus and clarity to costs and utilization so they can improve the services they offer to members.
How can data analytics support your plan? We’ve outlined five ways to make the most of your data:
- Enhance member engagement and experience – As reimbursement shifts from volume to value, analytics tools can reveal the clinical opportunities that lead to healthier populations. St. Joseph Hospital, part of Covenant Health, leveraged MedeAnalytics Population Health to analyze their self-insured cost and utilization data. With those insights, they had the knowledge they needed to help improve the health and wellness of employees and their families while also reducing costs.
- Lower costs and improve affordability – With costs on the rise, it’s crucial for health plans to analyze healthcare economics to steer high-cost members toward quality care and pinpoint patterns that reveal opportunities for savings. With the help of our analytics platform, St. Joseph Hospital, gathered insights from their data and reduced total pharma costs by 20 percent and per member per month (PMPM) costs by 12 percent, saving nearly $2.5 million in 2016.
- Reduce operating costs and inefficiencies – Health plans are always looking to improve efficiency, grow revenue and reduce overall costs. With an intelligent analytics platform, health plans can increase value-based contracts and reduce outsourcing costs for quality reporting. Presbyterian Healthcare Services (PHS) uses MedeAnalytics in an effort to adopt a comprehensive analytics approach and establish a data driven-culture. With MedeAnalytics, PHS balanced their costs, utilization, quality, risk and outcomes.
- Improve client satisfaction and retention – Better employer communication leads to better client relationships. That’s why it’s important to foster a personalized, interactive dialogue. With analytics, your health plan can deliver highly tailored, automated reports to employers, increasing employer retention and improving client satisfaction.
- Increase profitability and revenue growth opportunity – Analytics provide health plans with the necessary tools to increase value-based contracts, allowing them to grow revenue by upwards of 25 percent. With MedeAnalytics, PHS achieved measurable ROI in clinical, operational and financial areas of their enterprise, realizing more than $11 million in savings.
The untapped data available to health plans is key to member satisfaction. Investing in an intelligent analytics platform can help uncover the valuable insights that help health plans achieve success in a new healthcare economy.
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
Best Practices for Providers Looking to Improve the Quality of Care
In all areas of healthcare, organizations are looking for innovative ways to reduce costs and improve quality. According to a new study published in Health Affairs, MACRA could reduce CMS physician services spending from $35 billion to $106 billion. MACRA is also leading the way towards quality healthcare by creating incentives and penalties for providers who leverage the program to improve quality and efficiency of care. For providers to succeed under MACRA, they must work collaboratively with payers to meet the quality objectives defined by CMS.
In order to qualify for incentives and avoid penalties under MACRA, providers have the option to choose from two payment models: MIPS and APMs. Under MIPs, providers’ performance on quality, EHR use and practice improvements will be measured this year to determine the incentives or penalties they will receive in 2019. CMS is expected to notify physicians who are eligible for the program by the end of the month. APMs give incentive payments to providers that offer high-quality and cost-efficient care and can apply to a specific clinical condition, a care episode or population.
This week, our blog shares three steps providers can take to help ensure they are successfully meeting the requirements under these programs:
- Ensure Access to the Correct Tools - In a recent blog post, John Hansel, vice president of provider solutions, notes, “CMS’ quality reporting is complicated. There are numerous requirements that providers need to meet – from patient satisfaction to Electronic Health Record reporting – which can be difficult to manage. To ensure healthcare organizations are on track with these measurements, they need to have the right tools and insights in place to meet CMS’ various measures.” As providers look to improve quality and find success with the ever-evolving quality measures, they must ensure they have the correct tools in place to find success in improving patient care.
- Work with Payers to Break Down Data Silos - Although there has been some improvement in breaking down data silos, data preparation still accounts for nearly 80% of the work included in acquiring and preparing data. This can prevent the health system from getting a holistic look at the total patient record. To steer away from these data silos, providers need to leverage their relationship with payers, who typically are the only entity that have the data required to create a holistic patient record. Payers can provide access to crucial information, including the care received when the patient goes out of network. Overall, the shift to VBC requires that payers and providers work together in this aspect.
- Adopt Technologies Aimed at Improving Quality Measures - To truly succeed in improving the quality of care for the patient, providers must adopt technologies that serve as a basis for their collaboration efforts with payers. These programs must be able to successfully measure and monitor quality measures and create data driven conversations so payers and providers are aware of how to best improve quality for their populations. MedeAnalytics’ quality management solution offer insights that enable health plans to fully understand performance on quality measures and ultimately improve quality care for members.
At the end of the day, providers should be aiming for one goal: to improve patient care. To successfully provide patients with the best care possible, providers must work with the right tools, successfully leverage payer data and adopt technologies that serve as a place for collaboration with payer partners.
For more on how your organization can best improve the quality of care for your members, access our whitepaper, Enabling Payer and Provider Collaboration in the Journey Toward Quality Care. To find out how MedeAnalytics can act as a strategic partner in this journey, learn about our quality management solution 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.