Providers who manage value-based contracts are looking for ways to improve clinical outcomes and reduce costs. And they’re doing this by acquiring care management strategies and an ability to build better predictive risk models for high-risk populations.
With a just small sliver of the U.S. population accounting for a bulk of health care costs, provider groups are turning to predictive modeling systems to better anticipate readmissions and segment populations to improve care management.
Using data analytics, care coordinators can reach out to patients to make sure they’re seeing their physicians, taking their medications and understanding the directions they may be getting from different providers.
For example, an organization may be aggressively treating a cohort of diabetics, but without predictive modeling data, physicians may not know that half of them are depressed—and that may lead to worse outcomes. Knowing this information allows doctors and case managers to get those patients the mental health services they need. By doing so, those patients may be less likely to be readmitted.
In addition to helping coordinate patient care, data analytics can also give organizations insight into their financial risk. This calls for sophisticated predictive models that account for the health of an organization’s patient population. Episode grouper technology—the same technology payers use to aggregate and assess data—is useful in this area. Using claims data to analyze past expenses combined with a disease knowledge base, groupers can apply advanced risk analytics to show organizations the cost of caring for a group of patients in the coming year. Such information is invaluable for budget and staff planning.
By applying advanced analytics to broad, inclusive data sets, providers will have a sharper lens with which they can analyze the inner workings of their systems. They can see what’s working, what’s not working, what it costs, and whether it could be more efficient. Data allows them to better understand their populations, then tailor the care they provide to suit patient needs.
Providers can use analytics to gain the knowledge they need to improve, manage and succeed in today’s dynamic, value-based health care market and prepare for tomorrow’s challenges.
For more on using analytics to turn big data into good data, download “Getting from Big Data to Good Data: Creating a Foundation for Actionable Analytics.”
–Jeremy Orr, MD, MPH, Chief Medical Officer, Optum Analytics