Healthcare Analytics, Population Health Management, Healthcare Big Data

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Clinical Analytics Aid Payers, Providers with Value-Based Care

Clinical analytics and data integration are becoming top tools for healthcare payers and providers as they navigate the value-based care environment.

Clinical analytics and value-based care

Source: Thinkstock

By Jennifer Bresnick

- Clinical analytics and data integration are helping health payers and providers boost quality and meet the challenges of value-based care, says the 8th Annual Industry Pulse Report from Change Healthcare and the HealthCare Executive Group.

Data analytics skills are crucial for helping insurers and provider organizations address key population health management concerns, including the social determinants of health and patient engagement – and big data is becoming increasingly important over time.

Compared to data from 2016, stakeholders in 2017 were more likely to say that clinical analytics helped empower productivity among providers, enabled better engagement, enhanced efficiency across the delivery system, and bolstered population health.

As payers and their provider partners move more deeply into risk-based reimbursement, they will need to continue to improve their data analytics skills to change behaviors, clarify the criteria around value-based care participation, and reduce administrative burdens.

"The Industry Pulse results clearly underscore some of the megatrends we're seeing this year, especially with respect to transformation of care, including population health management, analytics, and consumer engagement—which are pillars of value-based care," said David Gallegos, senior vice president, Consulting Services, Change Healthcare.

READ MORE: Identifying Big Data Sources for Population Health Management

"Healthcare organizations are transitioning from negative to positive incentives to influence consumer behavior much faster than most would expect. Payers are also taking aggressive steps to advance value-based care and crack the code to successful consumer engagement."

Analytics will be an important part of navigating an increasingly risk-based care environment.

Risk-sharing arrangements, including accountable care organizations (ACOs), are becoming more and more popular, with 45.6 percent of payer and provider respondents currently engaged in the strategy

Forty-three percent of participants are undertaking pay-for-performance agreements, and full capitation is in use at just over a third of organizations.

As a result, providers and payers are facing challenges both internally and externally.  When asked about the top barriers to value-based care adoption, 38 percent cited the “complexity of changing physician behavior,” followed by 37 percent who said “resistance to change” was their biggest obstacle.

READ MORE: What Are the Social Determinants of Population Health?

More than a third added that insufficient health IT tools were hampering their efforts to transition away from fee-for-service, leaving them struggling to adequately address patient engagement concerns and integrate interventions around the social determinants of health into the workflow.

Importance of clinical analytics to healthcare payers and providers

Source: Change Healthcare / HCEG

Both payers and providers are optimistic that clinical analytics will smooth over some of these bumps in the road, however.

Two-thirds believe that analytics have already started to empower more productive providers, and three-quarters think data is enabling better engagement.

Over 65 percent of respondents stated that clinical analytics has improved their overall workflows, at least moderately, while 73 percent said analytics has positively impacted their ability to engage in population health.

READ MORE: Population Health, Big Data Strategies Could Reduce $2B Waste

Integrating clinical data into the administrative process has also helped to bring new insights, but ensuring that this data is accessible and used correctly for reporting remains a significant concern.

More than 63 percent of payer and provider respondents said that clinical data integration was a top driver of administrative efficiencies, underpinning the entire analytics process.

While organizations are interested in using cutting-edge techniques like artificial intelligence and blockchain to streamline the administrative process, they acknowledged that data integration is a problem they must solve first.

“Improving integration between financial, clinical, and systems data for administration and payment of care was also cited as a prerequisite for many of the other technologies posited in this question,” the report says. “For example, analytics, AI, and blockchain are most effective when they have access to complete data sets.”

With more comprehensive datasets in hand, providers and payers will be able to tackle their other main challenges, including member engagement and retention, customer service, and attracting new consumers to insurance products and healthcare delivery networks.

The survey results mirror other recent industry polls that identify population health management and value-based care as ongoing challenges across the payer-provider ecosystem.

Earlier in February, 84 percent respondents to a Deloitte and NEJM Catalyst poll said big data analytics was “very” or “extremely” important for their long-term success in the competitive, risk-based healthcare environment.

Fifty-nine percent stated that analytics to support improved population health management was one of their primary goals.

To succeed in this increasingly complex environment where data-driven insights are a fundamental component of care quality improvement, healthcare providers and payers will need to focus on revamping their health IT systems to allow for deeper integration and more robust analytics, says Change Healthcare.

“Healthcare delivery and reimbursement have changed dramatically since the 1990s—yet many organizations continue to use information systems that are out of step with today’s requirements. These old systems increasingly can’t meet the automation, interoperability, and data processing demands of today’s healthcare market,” the report concludes.

“Adoption of contemporary technology is essential for healthcare organizations to compete in an industry that’s transforming rapidly, including value-based care, price-and-quality transparency, improved collaboration, optimized patient experience, advanced cybersecurity, and more.”


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