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

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

The future of digital health part 3: AI, machine learning and robotics

May 4, 2021

This post is part three of a new series featuring healthcare visionary and thought leader Andy Dé. In this series, Dé discusses 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...
The future of digital health part 4: Convergence of AI and analytics for healthcare payers

The future of digital health part 2: Digital patient engagement and virtual healthcare delivery

April 27, 2021

Protecting the health, well-being and safety of healthcare practitioners and first responders is paramount — and will accelerate adoption of Digital Patient Engagement (DPE), enabled by Virtual Healthcare Delivery (VHD) solutions (also known as “Hospital at Home.)”

Read on...
You're asking too much of your EHR

You’re asking too much of your EHR

April 8, 2021

Electronic Health Records (EHRs) are purported to do a lot of things to support healthcare providers, and most of their claims are generally accurate. Of course, like anything, there are many areas where EHR vendors could and should make improvements.

Read on...
Gamification in healthcare only works if you can measure it – here’s how

Gamification in healthcare only works if you can measure it – here’s how

March 17, 2021

In business and in sports, it’s all about teams. What teams can accomplish when they work together. How they can fail spectacularly when they do

Read on...