Deriving Value in Healthcare

Although the primary focus is saving lives, healthcare is still a booming industry that relies on growing profits to maintain competitiveness. In many industries, the products and services offered are standardized or systematic, making it possible to . However, healthcare is caring for patients who are all different and unique which makes calculating cost, profitability and value a big challenge. With all the new technologies in finance and analytics, it is time to take another look at how the healthcare industry can use these tools to gain a full picture view of their patient data, analytics and how they can innovate

More healthcare executives are beginning to favor a value-based system that focuses on quality instead on quantity, making patients the priority. To accomplish this, healthcare facilities are focusing on evidence-based care, analytics and innovation so patients can get more value for what they pay for. These days, data driven insights and decisions are vital across the healthcare spectrum to allow providers and patients to take full advantage of this value-based system.

Data Management

Traditionally, healthcare organizations have relied on medical records and utilized data to analyze patient populations and the health of individuals. While Electronic Medical Record (EMR) and Electronic Health Records (EHRs) were seen as an adequate source of data for healthcare analytics in the past, the demand for detailed and actionable insights has dramatically increased.

A whitepaper by Linguamatics Health, Mining Unstructured Patient Data for Successful Population Health Management, states that “Shifting payment models based on quality and value are fueling the demand for comprehensive insights into the health of patient populations.” Providers and consumers are focused on improving health at the patient level through better care coordination by understanding events that affect the health of a population. This new outlook on medicine is also providing opportunities to connect genetic details with the environmental and lifestyle factors that affect the health of individuals. Doctors and other healthcare providers are now combining data from their EHRs along with population data to gain the insights to be able to determine the true cost of care for each patient.  This has also led to the quick adoption of data warehousing solutions for population health.

The volume of available patient data is increasing, and so is the need to analyze unstructured data in real time. Typically, the unstructured data contains clinical information based on physician details, pathology, radiology, discharge reports and patient-reported information. Doctors sometimes must use a subset of data for making patient decisions and assume it’s the entire truth. Now, they have the ability to see a comprehensive view of an individual’s health by utilizing the insights that were derived from the unstructured clinical data. Furthermore, by using a sophisticated, predictive tool alongside this data, healthcare providers can identify which patients are at a high risk for medication misuse or for a 30-day hospital readmission.

 Predictive Analytics

Finance professionals in the healthcare industry are realizing the need to integrate analytics into their organization’s business activities. Predictive analytics tools can reduce waste and improve care by forecasting the likelihood of an event, like hospital readmission or developing an infection, and allowing doctors to adjust treatments and services accordingly. Despite these tool’s power to improve patient care, most healthcare facilities aren’t using them yet.

An article from the Harvard Business Review, Getting By-In For Predictive Analytics in Health Care, discusses an interview of leading U.S. health systems and policy makers performed by their research team to better understand what is hindering the adoption of these tools and what facilitates a successful implementation. One of the most significant findings was that successful predictive analytics depends on getting buy-in at all levels from the start.

To start the process of getting healthcare executives to buy-in to the benefits of predictive analytics tools, managers must involve the right people throughout the entire process.

Implementing predictive analytic tools in healthcare represents an improvement in health or healthcare outcomes. One of the main reasons these tools are so underutilized is because frontline employees, such as doctors and nurses, don’t fully understand their value. Because of this, most successful programs start when there is a problem where predicative analytics can make a clear difference. For example, the article states that 50% of newborns will die from untreated sepsis (blood infection). Because of this, healthy babies are given antibiotics in the event they have sepsis, but these antibiotics can lead to complications and increased antibiotic resistance. Hospitals want to identify newborns at low risk for infection and spare them the unnecessary antibiotics. They can do this by using a predictive tool to reduce the use of antibiotics without an increase in sepsis-related complications.

Predictive analytics tools’ value may be quantified in terms of quality improvement, improved patient or healthcare provider satisfaction or increased efficiency. Successful organizations take the lifecycle approach to managing and maintaining these tools and including the costs in the annual budget. If done properly, the result can be an increase in high-value care and targeting appropriate care to those who need it.

Innovation

Driving healthcare analytics innovations from the perspective of health outcomes (delivery, quality, cost) first and foremost, rather looking for a quick fix can turn into tangible benefits for cost savings and customized care for patients.

Just like predictive analytics, innovation in the healthcare industry is necessary but very difficult to get buy-in from the right people. This industry is a tricky one for getting buy-in for innovation because you need to talk to legal, regulatory and compliance colleagues early on and explain why innovation is important to the business. Once they understand the benefits, it is easier to get started.

Innovation frequently occurs in that uncharted territory where regulations may not be well defined. Naomi Fried described how she shaped an innovation during her time as the Chief Innovation Officer at Boston Children’s Hospital in her article, Innovating in a Highly Regulated Industry Like Health Care. Her team realized the doctors at the hospital could use video conferencing to care for critically ill patients in small community hospitals. While the legal time was skeptical about patient consent, medical liability and so forth, they were on board after several conversations. The hospital launched a “Teleconnect” program that made video conferencing available to doctors and patients.

Conclusion

In conclusion, you can’t manage what you can’t measure. Gaining a comprehensive, data-complete view of any business includes having the right financial and patient data, strong analytics systems that can drill down to the process level and look at it from an activity-based-costing perspective, and leaving room for innovation.

ImpactECS provides the tools to calculate detailed, end-to-end costs at the lowest level of granularity for all clinical and non-clinical activities. To learn more, Start Here!

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