Given the financial pressures that lie ahead for providers as healthcare reform takes shape, analytics become the key to creating new business models that ensure financial viability while improving patient outcomes. Early definitions for meaningful use of healthcare data, for example, include metrics that report on the status quo. Meaningful use can extend well beyond this, by extracting the information that is hidden among the mountains of data collected.
By Rick Pro
Given the financial pressures that lie ahead for providers as healthcare reform takes shape, analytics become the key to creating new business models that ensure financial viability while improving patient outcomes. Early definitions for meaningful use of healthcare data, for example, include metrics that report on the status quo. Meaningful use can extend well beyond this, by extracting the information that is hidden among the mountains of data collected.
The mechanism for extracting meaningful and usable information from proposed new data repositories is dependent on the application of analytical techniques to the cleaner, more robust, more interoperable data repositories under discussion. Through such analytics, providers can predict patients’ future clinical pathways, including preventive-care opportunities, quantifying of best practices, predicting outcomes at the individual patient level, simulating the impact of new reimbursement methodologies and ensuring proper payment.
Opportunities for improved efficiency and effectiveness can be identified using advanced analytical techniques. Such analyses can uncover clinically relevant findings or simulate government reimbursement methodologies in ways that should prove critical in retooling provider practices under healthcare reform.
At the top of the hierarchy of advanced analytical techniques is predictive modeling. The objective is to move away from reacting to illness in the present and to move toward preventing illness before it happens.
In the provider world, such predictive analyses enable early intervention (i.e., the ability to proactively reach out to patients before serious health issues arise). The result is the ability to proactively keep healthy patients well through relatively low-cost engagement channels – such as telephone, e-mail and text messaging – while focusing in-office treatment resources on a decreasing number of seriously ill patients.
CareSource, for example, a Medicaid-managed healthcare plan that operates with a less than 6 percent administrative overhead, provides physicians with reports on all their Medicaid patients, showing information such as which children need lead testing and which diabetics are overdue for a blood sugar test. Staff can see if patients are visiting the emergency room for routine care and other key measures that assist with identifying gaps in necessary preventative care a member should receive.
With this information, many CareSource network physicians are calling patients to schedule follow-up appointments and testing. Such collaboration removes the full administrative burden of healthcare analytics from provider practices, yet allows practices to act on the results, improve outcomes and effect new efficiencies in care delivery.
Accuracy in diagnosis is critical because the reimbursement received from the Centers for Medicare and Medicaid Services is contingent upon the diagnosis. The cost of resubmitting claims can be thousands of dollars per case, while correctly diagnosing potential risk can save thousands of dollars for physician practices or millions of dollars for hospital systems.
One solution may lie in the emergence of software as a service (SaaS) in the health IT industry. Providers can submit EHR data to SaaS vendors through standardized data-exchange mechanisms. The EHR data then becomes the input to complex, often predictive analytical models built and maintained by the SaaS vendor. Providers then receive analytical results that highlight usable clinical or financial findings.
Rick Pro is health plans principal, health and life sciences global practice, at SAS, Cary, N.C.
For more information on
SAS solutions:
www.rsleads.com/910ht-206
