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

How to spark support for important analytics initiatives

How to spark support for important analytics initiatives

June 8, 2021

MedeAnalytics hosted a webinar with Fierce Healthcare to explore three industry experts’ perspectives on building analytics strategies and maximizing related…

Read on...
Pandemic devours hospital revenue; these ideas can help get it back

Pandemic devours hospital revenue; these ideas can help get it back

June 3, 2021

There’s no way around it. The coronavirus pandemic has created a perfect storm that, even as we progress through the…

Read on...
The Real Payback of Healthcare Analytics: Key Questions from Healthcare Leaders Around the Nation

The Real Payback of Healthcare Analytics: Key Questions from Healthcare Leaders Around the Nation

May 25, 2021

MedeAnalytics hosted a Fierce Healthcare webinar featuring key senior leaders from three preeminent healthcare organizations in the U.S: At the…

Read on...
The future of digital health part 4: Convergence of AI and analytics for healthcare payers

The future of digital health part 4: Convergence of AI and analytics for healthcare payers

May 12, 2021

This post is the fourth and final of our Digital Health series, featuring healthcare visionary and thought leader Andy Dé. In this series, Dé has been discussing how COVID-19 has triggered remarkable digital transformation and uncovers five long-term innovation implications that providers, healthcare leaders, and payers need to consider.

Read on...