Tuesday, 27 October 2015 01:48

It’s All About that Bass – Correction, Data!

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The transformation to value-based medicine is a herculean effort for the healthcare industry. The fee-for-service mentality remains heavily rooted at the core of the industry, although efforts to change are gaining momentum, both within the industry and government. Efforts to achieve the transformation include:

  • Payment reform methodologies that align appropriate risks and rewards based on indisputable performance metrics
  • Development, acceptance, and adoption of clinical and evidence-based guidelines and measures
  • Solidification of true collegial relationships within the entire healthcare system, including payors, hospitals, physicians, pharmacies, home care, long-term care, and patient advocates
  • Active patient engagement with self-monitoring, medical advice compliance, patient advocacy, and treatment protocol monitoring
  • Lastly, yet equally important, using data and information as the foundation for holistic insight and measurement

Just like the monotonous lyrics of the song, healthcare has become increasingly dependent on information technology, and as a result, it’s “all about that data!” The performance of the healthcare industry is being meticulously measured, rigorously analyzed, and publically reported – and this includes satisfaction, outcomes, cost, readmissions, wait times, access, and quality. To that end, we must continue to capture holistic patient data, improve analysis, and provide actionable information reporting in order to move the cost, quality, and satisfaction needles. Based on a recent Gartner survey of payor CIOs, the top priority for 2016 investments will be in business intelligence and analytics. 

Healthcare business intelligence is at an exciting juncture. Over the last few years, with the infusion of meaningful use funding, great success has been achieved to capture more structured data as the industry has moved from paper to electronic medical records. Patient-reported data has increased through health risk assessments and self-charting. The industry is at the cusp of fully leveraging telemedicine and wearable devices. With all of this structured data, the business intelligence value equation can evolve in the following ways:

  • From descriptive, which includes basic reporting and drill-down procedures…
  • To predictive, which is alerts, simulations, forecasting, and predictive modeling…
  • and to prescriptive, which is optimization and changing behavior

Data management and business intelligence strategies are often costly and time-consuming; thus, projects have a high risk of failure if they are not handled in a stepwise manner. Unwavering leader sponsorship, coupled with milestone visibility and promotion, is vital. In most organizations, the ideal executive to champion the data management and business intelligence initiatives is the chief operating officer, since C-level attention is paramount. A few key points on the roadmap to success include:

  • Ensuring that your data management strategies include the capture and analysis of administrative, clinical, and patient-reported information from payor systems, electronic medical records, and member/patient portals. All of these data elements are critical to ensure comprehensive line-of-sight into monitoring and management of quality, cost, and satisfaction performance.
  • Establishing a data/business intelligence governance structure that is represented by all departments – especially operations, medical, quality, and finance – to ensure organizational focus on the key metrics and corporate priorities.
  • Ensuring that your business intelligence initiatives are iterative to achieve incremental improvements so business customers see success quickly; this way, support for the business intelligence program will become contagious. Informatics is always ongoing, which aligns well to an iterative, agile approach.
  • Providing detailed drill-down information beyond just high-level metrics to ensure that actions can be immediately taken to improve financials, quality, and/or customer satisfaction performance.

The way that healthcare is delivered and financed will continually evolve going forward. Informed and targeted intervention – from wellness to chronic disease management – is vital to move the needle to improve results. The ongoing cycle of activities should include:

  • Defining a population for improvement
  • Determining care gaps
  • Stratifying risk
  • Engaging patients
  • Managing care
  • Measuring results

At one point in time, the stethoscope was the most important diagnostic instrument in medicine. Today, with the capture of more structured and unstructured data from electronic medical records, prescriptions, claims, eligibility, health risk assessments, self-reported activity, and telemedicine, information is now an equally important diagnostic instrument. The next transition for the industry will be to leverage actionable data within the clinical workflow process to improve the American healthcare industry, based on cost and quality, with an eye on going from last place to first in relation to other industrialized nations. Our medical bag of important diagnostic instruments now includes information technology. So, in the end, it is all about that data!

About the Author

As senior vice president of healthcare solutions for HighPoint Solutions, Jim is responsible for business and financial growth, new product/service development, strategic planning, business partnerships, and staff development across our healthcare practices. Prior to joining HighPoint, Jim spent 14 years as CIO and VP of enterprise operations at Priority Health. He has also held senior positions as JS Advisory Services, Ernst & Young, and the Henry Ford Health System.

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Last modified on Wednesday, 28 October 2015 02:06

As Senior Vice President of Healthcare Solutions, Jim is responsible for business and financial growth, new product/service development, strategic planning, business partnerships, and staff development across our healthcare practices.  Prior to joining HighPoint, Jim spent 14 years as CIO and VP of Enterprise Operations at Priority Health. He has also held senior positions as JS Advisory Services, Ernst & Young, and Henry Ford Health System.