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Analytics Magazine

Healthcare Analytics: State of healthcare analytics: A mid-year review

July/August 2015

Rajib GhoshBy Rajib Ghosh

As we enter the summer months, noteworthy news in healthcare analytics has somewhat slumped. Two healthcare companies went public recently. One is Evolent Health, which raised $195 million in its initial public offering (IPO) on June 4. UPMC Health Plan and the Advisory Board Company founded Evolent Health in 2011. It offers cloud-based analytics solutions for population health management. The second company, Press Ganey, is known for its patient experience and satisfaction survey capabilities. In operation since 1985, it works with many big healthcare systems in the country. Since patient satisfaction is a key metric for the triple aim (cost, quality, satisfaction), many insights are generated by applying analytics on the survey data. The company raised $223 million in a May 20 IPO. Look for more to follow suit in the coming months.

Patient Experience and Engagement

Patient engagement is becoming a ripe area for analytics. A study published two years ago in Health Affairs showed engaged patients have better outcomes [1]. Cleveland Clinic in 2013 demonstrated that too. When patients are engaged in a shared decision-making process about their condition, their health outcomes turn out to be better.

Patient’s experience with the health system is also key in catalyzing engagement. Better patient experiences drive better engagement and adherence to prescribed health regimens. [Editor’s note: For more on patient experience, click here.] Health systems and payers alike take weeks to collect patient feedback after the experience is delivered. Such delays inevitably introduce inaccuracies in the data. A New England Journal of Medicine (NEJM) publication pointed out that by focusing on timing and the context of the survey-based feedback collection improves the positive correlation between experience and outcomes [2].

While timing is great, an even better approach will be to customize the questions asked based on what answers are provided and the type of service rendered. An algorithmic decision tree-based survey model can be more meaningful for the patient, and the feedback provided will be more relevant.

Payment Reform: Catalyzing the Analytics Market

Payment reform is coming to the state Medicaid programs. Commercial health plans and Centers for Medicare and Medicaid Services (CMS) have started payment reform using 30-day bundled payments and Shared Savings Program. States mostly chose to wait and watch. That is changing.

The new model will pay providers a fixed amount on a per-patient-per-month basis with a potential incentive payment based on previously agreed upon performance metrics. Many of those metrics will be based on Healthcare Effectiveness Data and Information Set (HEDIS) tool used by more than 90 percent of America’s health plans to measure performance in care and service. Managing the health of the patient population will become the key focus area for providers as they eye the incentive dollars from the health plans. To thrive in payment reform the following changes need to happen:

1. Care delivery models need to be transformed so that care can be delivered outside of the usual in-person settings. If a lower cost option can satisfy care delivery needs without sacrificing quality, then providers need to adopt it. For example, care can be delivered via secure messaging or telemedicine. A physician assistant or a nurse practitioner can deliver care. Such models of care, called “alternative touches,” will be great if providers can identify when such care will be appropriate.

2. Certain populations of patients will have to be seen routinely for prevention and screening. For example, children in the managed population need to be immunized to prevent other fatal disease outbreaks. Capturing data on demographics and history and real-time metrics calculation will be key to drive alerts and an outreach program.

3. Providing adequate access to healthcare will be important. Providers will have to track patient satisfaction regarding healthcare access and use analytics to build capacity plans.

4. Identification of high-risk high-users in the managed population will be extremely important. This not only helps providers do preemptive intervention, but it also helps in identifying such cohorts and constantly tracking them – a key for cost containment given the capitated environment.

Reduction in emergency room visits and preventable hospitalizations are also high on the new payment model pilots. As I have mentioned in previous columns, most of this can be achieved using descriptive analytics. But having the right data will be the key. Interestingly, Electronic Health Record (EHR) systems, though ill prepared for this model, are rushing to provide population health management solutions to capitalize on this impending demand.

The problem is, effective management of population health requires not just the EHR data but also cost data that providers do not usually have. On the other hand, payers have cost data from claims but not always EHR data unless they do so through some integrated partnership model with their partner provider organizations. This is a key issue since in absence of a robust statewide Health Information Exchange (HIE) model, different data sources are still siloed. Integrated delivery networks such as Kaiser Permanente or health systems with insurance businesses (e.g., Intermountain Healthcare or Geisinger) are better positioned to deliver a more comprehensive population health management program.

Insurance payer Blue Cross Blue Shield of Tennessee has developed an analytics platform based on various sources of data to help providers identify gaps in care. They have also integrated a marketing platform that can generate targeted marketing campaigns based on these insights. Smaller providers without the wherewithal to create comprehensive population health management analytics can take advantage of this platform to meet requirements for the payment reform. However, for state-run Medicaid programs it is unclear who will take the lead and deliver such a comprehensive solution.

As the reform deadlines get closer and demand for such solutions intensifies, I expect to see creative solutions springing up across the nation during the next few years.


Rajib Ghosh (rghosh@hotmail.com) is an independent consultant and business advisor with 20 years of technology experience in various industry verticals where he had senior-level management roles in software engineering, program management, product management and business and strategy development. Ghosh spent a decade in the U.S. healthcare industry as part of a global ecosystem of medical device manufacturers, medical software companies and telehealth and telemedicine solution providers. He’s held senior positions at Hill-Rom, Solta Medical and Bosch Healthcare. His recent work interest includes public health and the field of IT-enabled sustainable healthcare delivery in the United States as well as emerging nations. Follow Ghosh on twitter@ghosh_r.

REFERENCES

  1. “Health Policy Brief,” Health Affairs Blog, Feb. 14, 2013 (http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_86.pdf).
  2. M. P. Manary, W. Boulding, R. Staelin and S. W. Glickman, 2013, “The Patient Experience and Health Outcomes,” New England Journal of Medicine, Vol. 368, No. 3, pp. 201-203, Jan. 17 (http://www.nejm.org/toc/nejm/368/3/).

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