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:

  1. Identified healthcare utilization to improve care for employees and their families
  2. Designed benefit plans
  3. 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:

  1. Created Value for Key Stakeholders 
  2. Integrated Payer and Provider Analytics
  3. 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: https://medeanalytics.com/company/contact.

Posted in

MedeAnalytics

MedeAnalytics is a leader in healthcare analytics, providing innovative solutions that enable measurable impact for healthcare payers and providers. With the most advanced data orchestration in healthcare, payers and providers count on us to deliver actionable insights that improve financial, operational, and clinical outcomes. To date, we’ve helped uncover millions of dollars in savings annually.

Leave a Comment





Get our take on industry trends

Optimize your midcycle for telehealth services

March 25, 2024

Telemedicine is now a permanent fixture in homes across America. A majority of healthcare organizations have established the technology necessary…

Read on...

Three ways to improve patient retention in recovery programs

March 6, 2024

Deaths from drug overdoses have increased from ~1 per 100,000 in 1999 to ~4 per 100,000 in 2020.1 The introduction…

Read on...

ACOs and value-based care in 2024: Four key questions and answers

February 27, 2024

ACOs have long been at the front lines of value-based care efforts. In a recent LinkedIn Fireside Chat, Andy Dé…

Read on...

How is telehealth impacting STARs performance?

February 21, 2024

STAR scores are a critical component of success for Medicare Advantage Plans, MSSP and REACH ACOs, driving them to maximize…

Read on...