Better use of data, demonstrating value of pharmaceuticals, opioid concerns lead SCIO Health Analytics’ predictions in 2018
The focus for healthcare in 2018 will be on fulfilling the promise of current technology advancements rather than breaking new ground, according to experts at SCIO Health Analytics in predictions released Dec. 20. The company, which offers next-generation analytics that help healthcare payers, providers, and life sciences organizations improve outcomes, lower costs, and drive value, expects that organizations in these markets will look to reap strong returns on technology investments they have already made rather than breaking new ground in 2018.
SCIO predicts that healthcare organizations will expand their use of data beyond traditional clinical, claims, and financial data to harness more demographic, behavioral, and other types of data from disparate sources. Rather than only looking at what happened, healthcare organizations will want to understand how they can influence behaviors of patients, providers, and others more effectively. Two aspects that will be critical to this focus on prescriptive analytics are natural language processing (NLP) and machine learning.
While the focus of the last few years has been on Big Data, SCIO believes the industry is shifting toward an elevated view of “little data,” i.e., being more precise in the interpretation of data which enables it to be applied on more of an individual basis. According to SCIO, each data set has particular value in utilization, and taking advantage of data layering to enhance the outputs will be critical. These types of analytics are highly valuable in spotting the outliers and trends that are easy to miss in a more macro-focused program. The breadth of data, combined with greater precision, will enable healthcare organizations to gain better insights and guidance on the new programs (and changes to existing programs) that will make them most effective.
To answer these requirements for a broader swath of data, SCIO expects data availability and transparency to be a top priority within the industry.
Of course, with the Equifax data breach and the hacking of the National Security Agency continuing to permeate the news, cybersecurity is certain to be a top priority for all sectors of healthcare. Protected health information has long been demonstrated to have far greater value than credit card or other types of data. As more healthcare organizations move data and analytics to the cloud, they will pay even closer attention in 2018 to all things cybersecurity.
As payers shift more risk to providers and life sciences organizations, collaboration is critical. Despite expected reductions in payments from the Centers for Medicare and Medicaid Services (CMS) for alternative payment models as a result of tax reform, SCIO believes the healthcare industry as a whole is still committed to moving forward with value-based care. In addition, the focus on outcomes will drive life sciences organizations to use analytics to demonstrate the efficacy of their treatments and work more closely with payers to ensure that information reaches prescribers and members.
Analytics will also be used more widely to enable payers to develop detailed profiles of provider performance. They can then use this information to recognize and reward high-performing providers through programs such as “gold carding,” i.e., pre-authorizing providers for more procedures based on their history of delivering quality outcomes. At the same time, the analytics will identify variations in provider behaviors that need to be addressed. By sharing this information in a collaborative atmosphere, payers will help raise the overall standard of care while reducing costs and increasing patient/member satisfaction.
The opioid abuse epidemic is a top-of-mind issue for many Americans, including President Trump. Analytics that can help uncover patterns of fraud, waste, and abuse of opioids among providers and patients will be in high demand. The question then will be what to do once they are discovered—especially on the patient side given that programs offering support and treatment for opioid abuse could face serious cutbacks or even elimination.
In 2018, SCIO expects that life sciences organizations will be held more accountable for proving the impact their drugs and devices have on improving outcomes for patients and populations, including sharing in the risk around those treatments. As part of this effort, they will need to demonstrate how they can help drive compliance and adherence rather than supplying the products and walking away. This mindset will become even more important for high-cost, high-impact specialty drugs. SCIO believes the industry will begin to test the thesis of outcomes-based contracting between Life Sciences and Health Plans and this will be phased over time from claims data to metrics on the health status of the patient.
Although there may be some uncertainty around the specifics, particularly in the current political climate, SCIO is confident in predicting that the move to value-based care that is already under way will continue. The ongoing shifting of risk from payers to providers and life sciences organizations is already accelerating. The need to think in terms of populations rather than individuals is given additional urgency by the growth of the Medicare Advantage population, where keeping patients/members healthier in the aggregate is critical to controlling costs.
