January 6th, 2016

The Convergence Of Business & Informatics Analytics

Mark McAdoo

The healthcare market is transitioning from a fee-for-service model to a more holistic, value-based payments (VBP) system. Rather than looking at individual parts of the care process and reducing cost in one area just to drive up cost in another, doctors, hospitals and rehabilitation specialists will need to work together to find overall efficiencies. The best way for a VBP system to be effective is to have granularity of information.

Traditionally, we have seen data work in two ways. The first is to form a group of very specialized technicians who analyze internal claims and look at trends. While the possibilities are endless with this kind of programming, it is cumbersome and slow to manipulate data and there has historically been a disconnect between the technical team looking at data sets and the end business users. In response to this, a group of Software as a Service (SaaS) products emerged that can generate set reports quickly. While these reports are easy and don’t require an analytics specialist, they are fairly limited in their scope and customization.

Neither of these solutions has been nimble or quick enough to inform health care companies as they navigate this new realm of VBPs. These new payment models require a level of collaboration between payers and providers that we have never seen before in health care. This demands a transparent sharing of detailed information that can support the dialog between payers and providers.

We have been collecting big data for years. Now we need to do three things. First, have enough data in one place consistently so that it can be analyzed. Second, define an analytic methodology that can be consistently applied. Third, harvest this data in such a way to produce actionable intelligence for all stakeholders. This is not just math or statistics, but we must organize data in such as way as to collaboratively design VBP systems that can improve quality, care and cost.

The demand for granularity of information converged with the evolution of technologies such as cloud-based computing, SaaS, and self-service business intelligence to generate a new category focused on using technology to find solutions to business problems. The newest options allow both the business managers, informatics professional and the care providers to have the data the way they like it. Business managers and care providers have a simple-to-use, web-based application that shows them costs and trends around individual providers, the information essential for collaboration among payers and providers. At the same time, the combo solution meets the needs of the informatics group to receive data that can be manipulated with their own business intelligence tools.

Legacy technology does not provide the information and support needed to scale and operationalize such a complex payment program, and this is creating a major roadblock for insurance companies. VBP as the preferred healthcare model is a wave that is building rapidly and only moving in one direction. You can determine where you are in the process by converting your data to intelligence, but you cannot do that with your traditional analytics application. Choosing a technology partner that knows how to take the advances in cloud computing, analytics and self-service business intelligence, and use them to inform strategy is essential to success in the evolving healthcare market. You must decide if you will lead the change and help form it, or get carried along behind with little control over where you land.

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