Can data drive healthcare reform?
Talk is cheap, except when it relates to the ongoing discussion about how to improve cost quality and access in healthcare. Most experts believe that to achieve this lofty goal, the collective industry must convert from the dominate fee-for-service reimbursement model to shared-risk arrangements. But how do we get a $3 trillion dollar industry to do a 180-degree turn?
The catalyst for change might just be in data—specifically, analytics that encourage better decisions at the point of care. But it will require a tighter collaboration between historic counterparts: payers and providers.
Healthcare organizations are deploying advanced EHR systems that generate electronic data that will ultimately supply intelligence on how to maximize the value of their healthcare services, including advanced tools that enable providers to monitor their ongoing clinical performance.
Going forward, however, it’s simply not enough for providers to monitor their internal results. The information also must be freed from the EHR and combined with data from other sources and distributed to healthcare leaders, empowering not just clinical, but effective business decisions. This is where health plans must step in with payer-centric data and sophisticated analytics … information that drives disease management and population health programs.
Data aggregators that have access to a treasure trove of claims and other data stand at the crux of both entities and are uniquely positioned to add great value to healthcare delivery. They are dedicating creative energy into leveraging their rich data sources to help providers gauge the impact that emerging payment models, including consumer-directed healthcare and performance-based reimbursements, will have on financial outcomes … an activity that was once the sole domain of health plans.
he data must have a level of granularity that will help institutions uncover inefficiencies in areas such as revenue management, clinical outcomes and utilization. When married with comparative data from other organizations, providers will have access to richer sets of information than ever before—intelligence that experts say will create the foundation of shared-risk arrangements, including bundled payments and incentives for payers, providers and even patients that are based on quality outcomes.
Ultimately, everyone will benefit from the emerging ties that will bind all the players together. Group hug anyone?