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GE Healthcare Camden Group Insights Blog

Utilizing Analytics to Measure Risk and Evaluate ROI in Your Organization's Value-Based Care Initiatives

Posted by Matthew Smith on Oct 4, 2016 2:06:19 PM

By Shaillee Chopra, PMP, Senior Manager, and Daniel J. Marino, MBA, MHA, Executive Vice President, GE Healthcare Camden Group

Data AnalyticsHealthcare organizations transitioning from fee-for-service to value-based models are making substantial investments in building technology and operational infrastructure to drive new services and workflows. Developing an effective and an efficient care delivery system from which to identify and drive profitability under risk arrangements remains of utmost importance. However, developing an analytics framework to support population health management, evaluate potential and expected returns from investment continues to be a struggle for many healthcare organizations.

Creating an analytics-based evaluation model enables healthcare organizations to quantify risks and evaluate viability and value-add of outcomes associated with various decisions. It also allows them to measure and track return on their investments in technology and resources associated with various programs aimed at managing health of populations they serve.

An Analytics-Based Value Model for Population Health

The framework for this model is grounded in measurement of utilization by place of service. It provides near real-time insight into “what works and what does not” in an operational environment. It also serves as a mechanism to ensure an organization’s positive position during re-contracting discussions with payers since it is supported with demonstrable value of delivering the right care to the right patient at optimal cost in the most appropriate setting. It serves as an information-based decision making model that enables the organization to make the transition to pay-for-value while preserving margins and without upsetting the apple cart of existing payer -provider relationships.

The Need for a Value Model Within an Organization’s Population Health Framework

A value model allows your organization to develop a deeper understanding around which variables drive outcomes that impact decisions about investments and resource allocation. For example, high-performing and value-based organizations are committed to improving quality and reducing avoidable utilization and costs. Cost reductions are a byproduct of the reduction in avoidable ER and acute inpatient utilization for individuals with chronic conditions. These costs are offset by an increase in “good utilization” such as increased PCP visits, wellness screenings, and pharmacy costs associated with medication adherence.  An analytics-based value model allows your organization to meaningfully sift through large amounts of data to identify and isolate important variables for future strategic success.

It allows for assessment of returns on investments made in various disease management intervention programs for at-risk, rising-risk and chronically ill population cohorts. It identifies assets and value levers that can be leveraged to prioritize and tweak the operational models for optimal returns.

Finally, it allows your organization to use analytics as a cornerstone for an innovative and data-driven approach to population health management.

Key Questions to Ask Within Your Healthcare Organization

Top performing healthcare organizations that are invested in developing their analytic capabilities begin with the end in mind and work from an analytics roadmap. Below are some of the key questions to consider to ensure you are achieving outcomes you desire without “boiling the ocean” and wasting valuable resources on programs that have minimally aligned outcomes:

  • What are the key questions you want to answer? Do you have 3-5 clearly defined use cases?
  • Accuracy, validity and credibility of your data: Do you know what data is needed? Do you have the right data? Is the data useable, i.e., accurate and credible? What data do you not have? Do you have a data acquisition strategy?
  • Analytics roadmap: Have you established a needs based analytics framework within your organization? Do you have right skillset and adequate tools to conduct analytics? After you perform analytics do you know how to interpret the results and make them actionable?
  • Driving actions: Do you have an actionable strategy for executing on the results? What are the actionable opportunities to execute against? How are you evaluating competing analytic priorities for resources and investment?
  • Monitoring impact and evaluate results: Have you implemented processes to track performance as part of your activation plan? Are you tracking both outcomes and the steps required to achieve the outcomes? Are you leveraging predictive modelling to consider varied “What if” scenarios to continually optimize the focus areas of your operational work plan?

Utilizing an analytics-based value model allows your healthcare organization to optimally invest resources and dollars towards operational programs that generate outcomes and value most alignment with strategic goals.

Value Model, Health Analytics


chopra2-110511-edited-239718-edited.jpgMs. Chopra is a senior manager with GE Healthcare Camden Group and specializes in developing and managing innovative technology portfolios for value-based and clinically integrated healthcare networks. She is highly experienced in leading information technology and consumer experience strategy development, as well as transformations to enable clinical integration, accountable care, and population health management strategies for organizations invested in innovation and transformation of care delivery models. She may be reached at shaillee.chopra@ge.com.

 

Marino_Dan.jpgMr. Marino is an executive vice president with GE Healthcare Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. With a comprehensive background in all aspects of practice management and hospital/physician alignment, Mr. Marino is a nationally acknowledged innovator in the development of Accountable Care Organizations and clinical integration programs. He may be reached at daniel.marino@ge.com.

Topics: Value-Based Care, Healthcare Analytics, Daniel J. Marino, Data Analytics, Shaillee Chopra, Digital Health Services and Data Analytics, Value Model

Determining ROI From Your Analytic Technology Investment

Posted by Matthew Smith on Sep 8, 2016 8:49:14 AM

By Mmekom Ekon, PMP, Consultant, GE Healthcare Camden Group

healthcare_analytics.jpgAs the healthcare industry continues to make an accelerated move toward value-based care models, organizations are investing substantial amounts in analytic platforms to deliver insights that will drive  improved quality and reduced costs. Stakeholders also believe that these analytic solutions, with their predictive forecasting and trending capabilities, are key to successful value-based programs where they can help transform clinical and financial initiatives and address various regulatory and financial challenges that lie ahead.

The healthcare analytics market is stimated to reach $18.7 billion by 2020 (from $5.8 billion in 2015) at a combined annual growth rate of 26.5% during this forecast period. This places analytics among the top areas of spending growth for hospitals and health systems during this decade. 1 Given the projected increase in the overall analytics spend paired with low hospital operating margins, executives are faced with tough questions around return on investments on these technologies. Are these suite of business intelligence tools delivering as promised? How do you determine if these analytic platforms are providing value to your organization or if there’s any return on your technology investment?

Here are 3 key categories to consider when determining ROI on your analytics investment:

1. Organizational Penetration

What is the “analytics market share” within your organization? Who’s using it, and what is the percentage of your organization that uses or is aware of the capabilities of the analytic tool? Is there opportunity to “increase analytics market share” within your organization to get the tool to the right folks and get them to use the information from the tool?

The biggest challenges to the penetration of an analytic technology culture is fragmented ownership and limited access to skilled resources (super users) . A quick assessment of the departments and staff that use your current analytics platform will indicate how well your analytics platform is embedded in an organization, department, or individual workflows.

2. Utilization

What types of data and information are frequently produced from these reports? Without access to action-oriented reports with pertinent information, the ability to derive value from your investment is constrained. The true value of an analytic tool is to produce efficient and consistent reports. These reports are used at the executive or board level to make key decisions around hospital operations and allow key patient care staff (such as physicians, nurses, allied health professionals, and ancillary staff) to access key performance indicators and interactive dashboards. Such access allows them to deliver optimum quality of care while adhering to clinical best practices and minimizing costs for their patients.

3. Organizational Goal Alignment

What were your original goals for this investment? Can you tie any recent operational change to your analytic tool? The ability of your technology investment to contribute toward financial, clinical, and operational improvement projects is paramount to achieving value out of your technology.

Analytics has no value unless it is acted upon. Strong linkages to information produced from your analytic platform to cost and quality improvement is the chief value of any technology investment.

The successful use of any analytic tool requires establishing a framework that identifies the value-add of a product and its alignment to your organization’s strategic goals and objectives early on. Monitoring and measuring usability against this framework while adjusting utilization workflows and addressing organizational needs for data literacy and alignment with operational objectives are key factors that quantify ROI against your investment.

  1. http://www.marketsandmarkets.com/PressReleases/healthcare-data-analytics.asp

ekon.jpgMs. Ekon is a consultant with GE Healthcare Camden Group, specializing in the digital health and analytics. Prior to joining GE Healthcare Camden Group, Ms. Ekon served as a technology consultant with Crimson performance software. In this role, she managed several hospitals and health systems through Crimson software implementation to analyze and improve operational, clinical, and financial performance. She has also helped members to identify opportunities to improve operational, clinical, and financial performance as well as implement solutions to improve bottom line. She may be reached at mmekom.ekon@ge.com.

 

Topics: Value-Based Care, Healthcare Analytics, Digital Health Services and Data Analytics, ROI, Mmekom Ekon

Moving from Utilization Management / Referral Authorizations to True Population Health Management

Posted by Matthew Smith on Feb 9, 2016 4:28:16 PM

By Tawnya Bosko, DHA, MS, MHA, MSHL, Vice President, and Megan Calhoun, MS, MSW, Manager,                   GE Healthcare Camden Group

population_health.jpgHistorically, many organizations managing care in a risk-bearing structure such as independent practice associations, medical groups, or related enabling entities such as management services organizations have primarily concentrated on utilization management, referral authorization, and claims processing, with attention to cost containment and ensuring all compliance standards are met. These functions have served as an "operational core," focused on getting the job done and meeting necessary requirements.

As they evolve, these organizations realize that simply "getting it done" will not suffice; they need to increase the focus on the clinical delivery process in order to affect the health outcomes of their populations.

To read this article in its entirety, please click the button below to immediately access CAPG Health.

  Population Health

Topics: Population Health, Risk-Based Contracting, Healthcare Analytics, Tawnya Bosko, Megan Calhoun

Infographic: The Transformation of Healthcare IT

Posted by Matthew Smith on Sep 9, 2014 11:13:00 AM

Health IT, HIT, Data AnalyticsIt could be said that data is the fuel and HIT systems are the pipeline for managing Population Health. Building the data infrastructure for a population health program is a complex undertaking with considerable upfront investment. Provider organizations must build a strategy, manage their cost structures, and understand the accountable care functions and IT systems that are necessary to make ACOs, CINs, and other population health initiatives function properly.

This infographic by Logicalis examines the rapid change affecting the healthcare IT field--and provides some valuable statistics regarding:

  • Mobile Communications
  • Use of Analytics for Care Improvement
  • Patient Access & Engagement

To view a full-size version of this infographic, please click here.

Health IT, HIT, Healthcare IT,

 

Data Analytics, ACO, Healthcare Data

Topics: ACO, Clinical Integration, Population Health, HIT, Health IT, Infographic, CIN, Healthcare Analytics, Clinically Integrated Networks

Infographic: Telehealth Powers Population Health Management

Posted by Matthew Smith on Aug 21, 2013 4:33:00 PM

Telehealth, Telemedicine, Infographic, Population HealthHealthcare is hanging up land lines and plugging into videoconferencing, virtual visits and smartphones to fortify care management and expand reach to remote and vulnerable populations, according to 2013 market data from the Healthcare Intelligence Network. 

Telehealth, also known as telemedicine, is the remote provision of health care services enabled by technology. A continuum of successful telehealth applications have been demonstrated over the last twenty years, ranging from the transmission of digital photographs and patient histories for diagnostic consultation, to remote monitoring of physiologic data for chronic disease management, to interactive patient physical examination using medical video endoscopes and ultrasound over high-definition videoconferencing links. The common tie among these varied applications is that technology is used to improve access to health care services independent of geography.

The telehealth in population health management infographic is excerpted from 2013 Healthcare Benchmarks: Telehealth and Telemedicine and was produced by The Healthcare Intelligence Network.

 

Population Health, Telehealth

Topics: Population Health, Healthcare Analytics, Telehealth

Infographic: The Intersection of Healthcare & IT

Posted by Matthew Smith on Aug 15, 2013 3:18:00 PM

Healthcare Data AnalyticsIn the wake of health care reform, hospitals, case managers, payors, and other care providers are looking for new technologies that help reduce costs while providing better care to patients.

Given changing CMS reimbursement schedules, an area of critical importance is hospital readmissions. Remote patient monitoring enables clinicians to collect patient vitals and other pertinent information from the patient on a regular basis and manage their patients’ chronic illness care plans more proactively.

This new infographic from the University of Illiniois Chicago provides a solid overview of Health Informatics--including the direct benefits from utililizing health informatics. (Note: Please click infographic for a full-size version).



UIC’s Online Health Informatics Degree

Topics: EHR, EMR, CMS, HIT, Health IT, Infographic, Healthcare Analytics

New Study: Big Data Targets Population Health, Revenue Cycles

Posted by Matthew Smith on Aug 13, 2013 5:08:00 PM

Population Health, Revenue CycleHospitals and health systems are putting data analytics into action at a rapid rate, according to a new survey fielded by the eHealth Initiative and College of Health Information Management Executives (CHIME) this summer. 

Nine out ten hospitals are using some form of big data analytics to manage their revenue cycles and to improve quality of care, and 82% identified population health as a key area that could benefit from detailed data analysis.  The survey shows that organizations aren’t just collecting data to meet meaningful use and other reporting requirements: they’re actively using their information as a business tool at a time when hospitals are fiercely competing with each other for revenue.

The Necessity of a Bi-Directional Exchange

Of the 102 respondents to the survey, the vast majority believe bi-directional health information exchange with other local organizations is critical to their ability to receive, process, and use data appropriately.  Analytics is also key to partnerships with health plans and payers: eight out of ten use analytics to examine denial rates, take back rates, claim and payment volumes, and outstanding receivables.  Two-thirds of organizations also use analytics to identify fraud and abuse, while other areas benefiting from the wealth of standardized data include cost forecasting and care utilization analysis.

Staffing Limitations

But despite the interest in analytics, hospitals are running up against several significant barriers, including a lack of trained candidates for new positions.  Only 18% of participants said that they were able to properly train their staff on data collection, processing, and analysis, and many have hired third party organizations to take care of their analytics needs for them.  Sixty-four percent indicated that they don’t do it themselves due to a lack of qualified candidates, while 34% say that senior management simply hasn’t prioritized analytics as an area for funding and development.

Analytics Pushed to the Forefront

That might start to change as payment models and public quality rankings increasingly start to rely on the examination of readmissions data, patient outcomes, and cost of services, however.  Inpatient care utilization and outcomes analysis and adverse event reporting were identified as areas ripe for growth when it comes to using data effectively, and three-quarters of organizations reported using administrative and claims-based data for these purposes.  The boost in the granularity of claims data associated with ICD-10 is also likely to push analytics to the forefront as structured data becomes ever more accessible.

Whether conducted in-house or outsourced to dedicated business partners, analytics is clearly top of mind for large healthcare organizations in 2013.  Hospitals aren’t stopping after implementing health IT systems capable of collecting standardized data: they’re interested in doing something with all that information.  By working with health information exchanges, accountable care organizations, and other industry partners, hospitals will be able to paint a big picture with big data, and use the findings to boost quality care and their own financial bottom lines.

Topics: Population Health, Healthcare Analytics, Revenue Cycle, HIE

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