In a value-based reimbursement setting, your most important technology assets may be your data. That’s because data, coupled with the right analytics capabilities, can help you focus on the patients and the conditions that have the most potential for cost savings and care quality improvement. And isn’t savings and care improvement what this “value transformation journey” is all about?
Data in and of itself is of little use unless it is turned into “actionable” information to support changes in population management and clinical processes. Using clinical data from medical, surgical, emergency, lab, pharmacy, radiology departments—and coupling such data with claims data—ACOs and other organizations apply comparative and predictive analytics to build a comprehensive, real-time picture of patients’ health risks.
Analytics and predictive modeling tools help organizations identify high-risk patients, a critical capability to organizations participating in value-based contracts. These tools can also help providers predict with a high degree of certainty if a patient could become high risk, determine the most effective interventions for a given population, and analyze clinical performance. Additionally, a single shared analytics and predictive modeling platform can drive transparency across participants, allowing for proactive communication around outcomes, variation of care, and population management.
Organizations in value-based contracts use tools that identify high risk populations, as well as but that also predict outcomes, such as who has the highest potential for hospitalization within the next 12 months or who will be a frequent emergency department visitor.
Providers will find tremendous value in leveraging data to persuade physicians to improve the way they practice. “It’s really nice to walk into a physician’s office and say, ‘What do you think? What should you do about this?’,” one physician told us recently. “But then you also need to have a way to show them the effect that care improvement has on their bottom line.”
“I think that actually takes software and people—people who the physicians respect to sit down with them and say, ‘This is where the gaps are; this is how you can do better’,” he said.
It all starts with the right data and analytics. Speaking about a new alliance that combines Mayo Clinic data and Optum analytics, Optum Labs, Mayo CEO John Noseworthy, MD, anticipated significant benefits for his patients.
“This alliance will allow us to create a data-driven, transparent system to identify what works,” Dr. Noseworthy said. “How much does it cost? Who’s doing it best? It is a necessary springboard for future innovation to drive up the quality of the care that we give and drive down the costs of health care. As results are known and broadly shared, patients, providers, and payers can seek and reward those who are providing the highest value.”
“Navigating the transformation journey” previous posts:
- Managing population health yields cost and quality improvement
- Value-based care delivery models that support integrated population health management
- Addressing reimbursement issues head-on
- Improving financial performance through coding and documentation improvement
- Putting clinical to work
- The role of patient access and medical necessity
- Navigating the journey from providing care to managing health