Health Plans: Extract More Value From Your Data Analysts | Geneia

Health Plans: Extract More Value From Your Data Analysts

November 01, 2017
Kevin Rill, Head of Solutions Architecture

Quote on top of image of health data analysts 


Data is at the heart of every healthcare organization and is a prized and valued resource. Finding the right focus for your data strategy can – and will -- make all the difference to your ongoing success, whatever evolving variations and combinations of value-based and fee-for-service care the future holds.

I’ve been on the frontlines of healthcare analytics for more than 20 years and can tell you that still today, far too many analytics shops are spending as much as three-quarters of their valuable time pushing and pulling together, validating and managing data with only one-quarter of the time left for uncovering insights to improve decision making.  

That’s a big problem.                                                              

Thankfully, for our clients, it’s a diminishing concern because, from the beginning, we insisted on building the best foundation for healthcare decision making. That meant developing a holistic architecture that quickly adapts to evolving reimbursement models, quality initiatives and care coordination needs. One that delivers up consistent insights across healthcare organizations – from the financial and business needs to the needs of front-line care teams and consumers. And finally, it means delivering a foundation that can be up and running in weeks, not months on end.

Healthcare demands flexibility

Healthcare data is generated every day, everywhere, from many different sources – from personal fitness devices to hospital stays with multiple services, tests, treatments and transitions.

These widely scattered data sources (from clinics, hospitals, providers, payers, community services, labs, devices, pharmacy) can lead to multiple, conflicting and confusing data streams that offer little value in their native, isolated forms.

Looking ahead, the challenges grow as we collect even more data, more types of data and explore more uses for it. For example, social determinants of health (SDoH) and remote patient monitoring data are two emerging fields that already help us better understand, predict and prevent adverse health and cost outcomes today, even though we utilize only a portion of the generated data.

And that’s the heart of it -- data is just noise without meaningful interpretation. And meaningful interpretation isn’t possible without a solution that provides data matching, standardization, curation and enrichment. It’s this process that blends multiple raw data sources into cohesive information to drive better decision making within the clinical, administrative and financial workflows across the healthcare organization.

Providing a solution that adapts to and integrates a broad range of data feeds removes huge, frustrating barriers for data analysts. Their work becomes exponentially easier as does their ability to bring together all the data that tell the real story for each member-patient, each site of care and the healthcare system as a whole. 

Data Transparency

Most healthcare organizations have separate solutions and reporting systems for:

  • Performance management
  • Contract management
  • Employer group reporting
  • Clinical systems
  • Quality reporting
  • And more

Whether by design or default, these reporting systems often work in isolation, each with its own unique data source, business rules and methodologies. When you bring the resulting data together, they don’t jive – reports are incomplete, unreliable and not timely. Too many data analysts become bogged down with the laborious and near impossible task of trying to make sense of conflicting information.

To alleviate this problem, we built a single, harmonized platform that each user can access with a specialized lens for his or her unique perspective. Now, administrative reporting information is presented alongside financial and clinical data, so each user has a complete picture of each member-patient, each site of care and of the organization as a whole.

This is key – value-based care requires unprecedented data sharing and collaboration between constituents. Successful and forward-thinking healthcare organizations provide the tools that facilitate this type of transparent partnership.

When all business units have transparent access to the same data, then the analytics based on that data will be consistent and analysts can pursue insights that help payers and providers understand the actual drivers of quality, cost and care within their organization.  

Population health initiatives can’t wait.

Speed matters. Health plan and physician leaders must continuously know how different and changing risks in their populations can impact their payment structures and care initiatives. This is a complex endeavor and few fully understand how to anticipate how everything can – and is likely to – come together.

This data-driven knowledge cannot come in a year or two, it must arrive in time to impact behaviors and initiatives that have the best chance of improving cost and care outcomes now and whenever risk changes.

For many, the idea of implementing a full population health solution brings the knee-jerk reaction, “No way!” Believe me; I understand where you are coming from. But here’s the thing – healthcare organizations can evolve and be ready for the future.

Having consistent, trustworthy information available throughout your organization helps shatter departmental silos that act as barriers for collaborative strategic decision making. How can the siloed approach possibly continue during a time where the fundamental structures of healthcare payment are changing? Existing legacy architecture and systems are simply not agile enough to see us through these changes. It is becoming increasingly important for everyone throughout the healthcare organization to understand how each role and department fits into each reimbursement structure.

To ease the way for our clients, we offer an alternative to the classic all-in approach. Flexibility and scale of our solutions allow us to begin with an immediate focus on specific priorities, with plans to expand when you are ready. For example, if an organization already has accountable care arrangements in place, but is struggling with cost and use from a performance perspective, we can hone in on those areas, taking in just the necessary data feeds, and drive time to value in as little as 90 days. After that, we can branch out into quality reporting and point-of-care insights, pushing information into the clinical workflow or whatever makes the most sense given the unique set of financial and population priorities in play. In this way, we deliver continuous improvement built on a strong foundation of collaboration.

The reality is, every healthcare organization faces multiple, parallel paths forward in value-based care, alternative payment models and traditional fee-for-service contracts. The organizations best positioned for success in this ever-evolving environment are those that provide constituents with the right tools to tear down barriers and drive value.

Right now, healthcare organizations rely on data analysts to decipher the data and deliver usable information to various departments. Increasingly, these insights must arrive on the screens of professionals across the organization and the healthcare ecosystem, so they are available and useful at the moment of decision-making.

Delivering widespread insights for better decision-making begins with the right data strategy and foundation. There can be no doubt that those health plans best positioned to succeed are those that embrace a data foundation built on flexibility, transparency and speed to facilitate a higher level of productivity from their analysts.

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