With uncertainty surrounding the ACA and the new administration, payers and providers alike are facing many challenges. Payers are bracing themselves for the 20 million people who could become uninsured, 20 percent of providers remain unfamiliar with the requirements set in place by MACRA and 35 percent of providers are still not getting paid via alternative payment models. These challenges, in addition to any potential roadblocks from new policies, mean that the industry needs to have a strong understanding of where they stand in their journey to value and the potential risk they can feasibly take on. To understand this, healthcare organizations need a strategic partner that can provide best-in-class analytics and guidance on how to make the most of their analytics investment. MedeAnalytics’ consulting team helps clients across the nation better leverage their data and turn cost-saving opportunities into realities.
In this week’s blog post, we explored the current client landscape with Karen Mitchell, Group Vice President of Consulting Services. This Q&A highlights how MedeAnalytics’ consulting services are helping clients overcome their challenges to remain successful in the competitive healthcare landscape, along with her predictions and hopes for the industry throughout 2017.
1. What are some of the common challenges that healthcare organizations come to you with, especially with the uncertainty around the ACA?
Due to rising costs, the continued transition to value-based care and new CMS regulations, financial risks are greater today than they ever have been. Provider organizations are looking for insight into how they can accurately and appropriately bill to decrease denials, improve payment accuracy and ultimately increase revenue and cut costs. Our consulting services can help organizations better identify ways to manage their financial risk so they don’t inadvertently miss revenue opportunities or receive less reimbursement than contracts stipulate.
Payers are facing similar issues due to variations in the cost of services from hospital to hospital. For example, knee and hip replacements are very common operations in the U.S. with about 1 million done each year. In most cases, health plans are not incentivizing members to go to hospitals with lower costs and higher quality outcomes, putting millions of dollars on the line in potential losses from high-cost, lower-performance hospitals. We can help payers identify high-performing hospitals and collaborate on strategies that encourage members to use these top providers, all of which can generate major savings for all.
Analytics Are Nothing Without Action
Although the investment in health IT innovations continue to rise, with 56 percent of providers investing in IT this year, there still remains a disconnect on how to best leverage the data and insights that organizations have at their disposal. With a new healthcare economy focused on value, provider consolidation, consumers and changing reimbursement models, healthcare organizations need a holistic, enterprise-wide view of their business. They also need valuable data insights to tap into cost savings opportunities.
In this week's post, we continue to offer best practices that healthcare organizations can utilize to make the most of their analytics’ investments and turn those insights into action. Here are three key strategies that can make a significant impact on an organization’s financial health:
- Offer Self-Service Access to Business Users: In many cases, organizations have invested in creating an enterprise data warehouse, but the adoption of the platform is often delayed due to IT bottlenecks in reporting and analysis. By empowering business users with the ability to perform their own analysis to identify the root causes of trends, the speed from insight to action will increase.
Find New Value in Existing Claims and Billing Data: Most data warehouses focus on aggregating clinical data from EMRs, but many healthcare organizations fail to recognize the potential in claims and billing data. Most data models are built on this type of data, so their value should not be underestimated. Organizations should also recognize that most risk models and clinical measures, including CMS quality measures and HEDIS measures, are based largely on this data. By using this insight, organizations can better prepare for the changing risk models and clinical measures.
Learn to Work with Payer Data: As new payment models blur the lines between providers and payers, leveraging payer data has never been so important. By creating a data infrastructure and training your staff to manage and analyze payer data, organizations can develop analytics for utilization measures and per member per month (PMPM) cost. These insights can help support new business models and uncover nuances to create added value across the enterprise.
To obtain more strategies, check out our latest whitepaper, Harnessing Enterprise Data Analytics for the New Healthcare Economy, here. Learn more about integrated analytics for the healthcare enterprise 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.
Trends in Review: Looking Ahead to HIMSS17
Each year, the HIMSS conference brings together the brightest health IT professionals, clinicians, c-suite executives and vendors to discuss cutting-edge innovations and developments in the industry. With HIMSS17 right around the corner, here are the top three trends that we’ll likely see dominating the headlines:
- Big Data and Analytics Will Continue to Push the Industry Forward – A recent poll conducted by Healthcare IT News shows that Big Data and Analytics will be two of the most talked about topics at HIMSS this year. This has been a continued trend as there have been major investments in this field. In fact, a recent IDC report found that the analytics market will reach $43 billion by 2020. Analytics is a crucial tool for healthcare organizations, as it offers them a holistic view of their patient’s outcomes and cost saving opportunities within their supply chain. Healthcare organizations are continuing to invest in solutions that lend insights to improve patient outcomes while keeping costs down.
- Revolutionize Data Sharing – Sharing data securely will continue to be a focal point as the industry continues to track towards quality outcomes for patients. Despite progress, this effort has not been met without challenges. In fact, 45 to 54 percent of physicians reported burnout from using EHRs. Many believe blockchain, which is a sequence of every transaction made in the patient’s history, is the solution. John Halamaka, chief information officer at Boston-based Beth Israel Deaconess Medical Center, recently spoke about its potential and stated: “it’s the right time in our history to take a fresh approach to data sharing in health care.” The conference will shine light onto the industries willingness to work towards a new form of data sharing.
- Staying Competitive via Payer-Provider Collaboration – As the industry becomes more patient-centric and value-driven, payers and providers will need to increase focus on collaboration. Patients are becoming even more engaged in their own healthcare and will look to providers who can offer the best value and experience for their service. Health plans, a recent Deloitte report noted, will need to harness advanced information technology to assist in important interactions with members to offer value. Through payer-provider collaboration, organizations will have the opportunity to stay competitive and achieve patient satisfaction.
Amidst new legislation and investment in the health IT sector, tracking towards value is full steam ahead. Payers and providers will need to invest in solutions that help them achieve the triple aim. If you plan on attending this year’s conference, make sure to stop by and visit us at MP34 to learn more about our cloud-based payer and provider tools that help uncover business insights for nearly 1,500 healthcare organizations.