February 1, 2018
Payers, Providers Must Collaborate on Data
by David Hom
Healthcare payers and providers are discovering the value of sharing vast amounts of data -- but this must be just the beginning.
As value-based payment models become more common, payers and providers are realizing that there is value in working together to reach mutual goals. A complete view of healthcare quality and costs is critical when working under models that base payments on clinical and financial outcomes, and not merely on the volume of services provided. Payers and providers are discovering the value of sharing vast amounts of data — such as that in claims, clinical, social, economic, and more types — just to name a few.
Sharing is just a start, though. What is perhaps even more important is that these organizations need the ability to make sense of all this information. They need to understand that acquiring meaningful data is far more important than assimilating volumes of data. Once organizations have the right data, they can rely on predictive and prescriptive analytics to gain meaningful insight into the data to spot trends, performance outcomes, etc.
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In fact, according to a recent Society of Actuaries survey of 223 payer and provider executives, 90% of respondents indicated that healthcare organizations will not be able to navigate the financial and clinical challenges of the future without investing in predictive analytics tools.
The majority of payers and providers participating in the February 2017 poll agreed that predictive insights will be critical for the future of their businesses. More than a quarter of the respondents stated that they expect big data analytics tools to save them 25% or more on costs over the next five years. What’s more, 47% of providers and 63% of payers said they currently use predictive analytics tools. Over the next five years, just fewer than 90% of both payer and provider organizations said they will have adopted some form of forward-looking, big data analytics capabilities.
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A recent webinar presented by SCIO with Oracle Health Sciences, Payer Provider Convergence: Using Data to Strengthen Partnerships & Drive Outcomes, explored how payers and providers can share/analyze to increase collaboration and work toward improved health outcomes. More specifically, the presentation provided insight into how payers and providers can leverage data and analytics to advance goals such as:
- Managing Risk and Revenue
- Optimizing Reimbursement
- Improving Quality and Compliance
- Optimizing Provider Networks
This article was written by David Hom and Lesli Adams.