Data analytics helps providers glean insights from performance management measures and metrics that allow them to be financially viable under at-risk and pay-for-performance contracts. Using data analytics, hospitals and health systems can accelerate their path to value.
Giving providers control Many health systems under risk-based contracts do not have data on cost and quality measures, nor have they mastered or even developed the ability to calculate the measures reflected in these contracts. Worse, a lot of health systems are dependent on information or reporting from the payor, much of which comes from claims data alone and may be three or four months old and outdated by the time the health system gets it. This compromises an organization’s ability to adjust and improve performance. Providers may even be unaware that they are eligible for bonus payments. There are cases where payors call health systems and say, “We think you may be eligible for this bonus. Can you give us more data?”
But if providers used analytics to measure quality and performance metrics, they wouldn’t need to solely rely on payors for data. They would know where they stand relative to contractual performance incentives using their own data. Rather than getting a call from payors about their bonus eligibility, providers should be in a position to call insurance companies and say, “Our numbers show that we’ve earned this bonus.”
On the clinical side, analytics can be predictive and to a certain extent prescriptive. It can suggest modifications to clinical workflows to improve efficiency, for example, or generate models to determine how a proposed change would impact both care gaps and revenue. These types of analytics are important for determining where improvements and initiatives should be occurring and where opportunities should be optimized.
Critical to using analytics to accelerate the path to value is ensuring information is available to authorized users across the care continuum. This enables a healthcare provider to guide decisions from three perspectives – clinical (based on the best quality of outcome), operational efficiency, and financial impact. In a value-based world, all three matter greatly.
Analytics as a business solution While analytics historically has been considered a technology solution, a platform that provides transparency into clinical, operational and financial data clearly is more than that – it’s a business solution. The metrics and measures generated by a healthcare analytics platform provide actionable insights to improve outcomes across the enterprise.
