As the healthcare industry moves toward value- based care, reimbursement will be tied to quality outcomes achieved. While the concept is simple enough, operating under this model brings some complications. Advanced analytics can help healthcare organizations understand their current situation, what might happen in the future and what actions they should consider.
Below are five ways that healthcare organizations could accelerate their success with their value-based initiatives by leveraging advanced analytics:
#1: Get the full picture with a 360-degree view. When attempting to understand patient/member behaviors, trends, habits and actions, it is critical to bring together a variety of data sets to create a complete, 360-degree view of each member/patient and provider. By accessing data such as medical claims, pharmacy claims, enrollment, health risk assessment (HRA) and survey, lab and biometric, EMR/EHR, socioeconomic, etc., healthcare providers can make sound decisions based on facts to improve patient/member outcomes.
#2: Understand populations. Knowing the makeup of the population served is critical to the success of value-based initiatives. An organization must understand the clinical and financial risks that exist across their populations to implement programs to manage that risk. Analytics can help to categorize various patient populations as high, medium or low risk. Once an organization has identified where the risk rests today, they can use predictive analytics to predict where it is likely to surface in the future. With this knowledge, healthcare organizations can make more targeted interventions.
See also: Strategies to Master Massively Big Data
#3: Allocate resources. All healthcare organizations are managing their business with limited financial and human resources. By leveraging advanced analytics, those resources can be focused on areas that promise to produce the greatest return on their investment. For example, by assessing impactability (Impactability is predicting and identifying prioritized opportunities that have the greatest clinical or financial outcomes), healthcare organizations can determine how likely it is to reduce emergency department visits or in-patient utilization if care gaps are closed with specific patients/members.
#4: Avoid costly procedures and services. As healthcare organizations strive to deliver next-level quality care, they will begin to pivot to precision-level, personalized care management opportunities. One such method to raise the stakes is identifying the best care choices when working with conditions that lend themselves to preference-sensitive treatment options. This occurs when patients present with conditions or ailments where there are no definitive clinical guidelines and a variety of potential treatment options exist. For example, when patients present with knee or hip pain, surgery is not the only option. Indeed, providers, in some instances, could treat the pain just as, or even more, effectively with other less invasive options. Quality, cost and satisfaction can all be improved by providing the patient with education regarding more effective, less invasive treatment options with conditions such as uterine fibroids and endometriosis, bariatric conditions and low back pain. By understanding who is at high risk for these types of potentially avoidable procedures and knowing the total episode cost as well as the remaining time to use a less invasive option, care providers have the opportunity to reduce the number of invasive, costly procedures.
#5: Deliver personalized care. In most cases, healthcare providers find that delivering personalized care results in more effective care. But nearly all care management programs strive for personalized, effective care. So, what is the answer? The answer may lie in developing consumer types across populations. Consumer types is a method of categorizing patients/members based on like attributes such as age, gender, education, income, etc. By knowing the various consumer types and their attitudes that make up a population, healthcare organizations can develop, evaluate and market care management programs to the most effective patients/members. For example, if a diabetic patient lives in a food desert, it would be difficult to get them to comply with a healthy eating plan. Or, access to transportation may be a barrier to adhering to a medication plan, as patients might be required to trek to the post office just to pick up their prescription drugs.
At the end of the day, care givers seek to gain insight into not only what has happened, but what will happen and then what should I do about it. With so many competing priorities, it can be extremely difficult and overwhelming to know where to begin. By using advanced predictive and prescriptive analytics within daily workflow, healthcare organizations are able to confidently allocate resources to focus on high-value opportunities that will improve both clinical and financial outcomes.
Interested in taking a deeper dive? Check out our webinar titled 5 Ways to Use Data for Advanced Analysis.