Introduction – The role, and actual meaning, of analytics in healthcare

May 22, 2014
Ric Sinclair, Head of Product, ZirMed

Like the phrase Big Data, the term analytics means different things to different audiences, and both appear frequently in vapid, buzzword-rich pronouncements about the inevitable future of practically everything, which only adds to the confusion.

So instead, try thinking of analytics as meaningful visibility. It is a resource to help you make smarter calls on the decisions that can’t wait, and a source of insights into the otherwise unknown specifics of what’s driving long-term financial performance and population health.

Complex healthcare organizations (HCOs) need two types of visibility: horizontal visibility, meaning comprehensive aggregation of data across their entire enterprise, and vertical visibility, meaning easy access to the details driving their HCO.

In today’s turbulent healthcare environment, waiting for these forms of visibility isn’t a viable option.

Thankfully, and despite what you might have heard, this level of analytics isn’t dependent upon overhauling your data systems or building enterprise data warehouses. Much of the data you need is already available within your existing systems, and cost-effective forms of cloud-based technology already exist that make that data accessible and actionable, today.

Smarter decisions in the immediate and near-term

Healthcare executives can’t delay making decisions that directly impact or dictate their organization’s financial health for the following quarter, six months or fiscal year. Whether it’s finalizing the annual budget or negotiating payer contracts, piecemeal information on financial performance increases the risk of bad, or at least suboptimal, decisions. And when it comes to payer contracting, lack of visibility also weakens your negotiating position.

At the day-to-day level, analytics shows you where to focus your training and can help you prioritize staff time and other resources. It enables you to understand the details of your revenue cycle and A/R days, and see the historical and near-real-time differences between individual actors: which payers have the longest turnaround times for claims, for example, and which coders have the highest denial or rejection rate. Analytics empowers you to catch and address problems in your reimbursements before they become entrenched and erode a significant slice of your revenue.

Effectively analyzing data across your enterprise provides a clear picture of how changes and trends in the near-term affect your organization over time. Without those abilities, you’re flying blind toward a future that looks like … what exactly?

That’s the point. If you don’t know, you can’t plan effectively.

Let’s take referral patterns as an example. Analytics not only enables you to manage referral leakage and total cost of care, it’s one of your best sources of information for long-term acquisition and affiliation planning. Are patients being referred out of network for specific types of care? Do you have a sufficient number of specialists in your network to meet that demand? Where are the out-of-network providers located, and do you have good coverage in those areas? These insights can help you make business decisions that better serve your patient population while also keeping more care in-system.

That touches on perhaps the most important role of analytics in healthcare: supporting value-based reimbursement.

Aspects of revenue cycle analytics (like the referral example above) are already making their way into population health management efforts. Revenue cycle analytics can be especially valuable for managing population health and keeping a handle on costs, because the data it relies on is readily available and includes financial data as well as information on procedures and diagnoses. The overlap creates opportunities for HCOs to make smarter use of their resources, set standardized population health benchmarks and track improvements on outcomes to show, for example, reductions in emergency events for patients with disease management needs, or to easily track the completion of follow-up care regimens.

Revenue cycle analytics is a resource for increasing the effectiveness of disease management, in part because it’s built on standardized, increasingly scrutinized data, but its ability to support improved outcomes extends far beyond spotlighting near-term opportunity and risk. Analytics lets you see the inner workings of your HCO in a way that leads to better outcomes on multiple fronts: optimized financial performance, wise and forward-looking operational decisions, and improved patient and population health.

Whatever the future looks like, the only way to make it brighter is to shine a light on where you are and where you’re headed.

That’s why HCOs can’t wait around for analytics.

HMT editor’s note: 
We will trace the principles outlined above in action as we follow active ZirMed projects over the next several months. Our first ZirMed Living Case Study update will be posted in the “Online Only Features” section of the HMT website in June.

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