Jessica Smith

Healthcare Analytics – The New Age of Technology Innovation

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It’s no surprise healthcare analytics is a hot topic in the insurance industry today. New and enhanced Centers for Medicare & Medicaid Services (CMS) regulations that govern healthcare have become more aligned with technical solutions, moving health plans to adopt more cutting-edge analytics to drive decisions. With the passing of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physicians and physician groups will start to move more towards aligned analytics as well. The need to look at microanalysis increases each day, so in a day and age driven by data and technology, what’s next for healthcare analytics?

When someone mentions healthcare analytics, most people picture a slick dashboard or an easy-to-use Business Intelligence (BI) tool that provides readily available calculations at the click of a button, but the underlying foundation of analytics is so much more than that. Analytics are only as good as the data utilized to create the calculations and trends. Understanding the type of data utilized for calculations, how the data is stored, and how it links to other types of information will turn any common dashboard into a powerful tool your organization will be confident in using to drive business decisions. In the next few years, healthcare analytics will start to evolve and incorporate new technology with data advancements to provide the user more actionable, real-time results. In order to achieve this, there will also be more focus placed on:

  • Partnerships
  • Integration
  • Adaptability

Risk adjustment and Star Ratings are just two of the programs that highlight the importance of a health plan and provider partnership. With the development of Value-Based Payments (VBPs) and Alternative Payment Models (APMs), providers and provider groups will be more inclined to partner with health plans. One of the most impactful ways to partner will be through data. Let’s take a minute to step back and think about all of the data that exists for a person and how it can be utilized to provide that individual with the best care possible. There are devices such as Fitbit, smartphones, and other various mechanisms available to collect patient information in real-time and transmit the results to the physician to monitor from a remote location. On the other side, health plans collect important and useful information through their disease management programs and other various avenues. Being able to cross-functionally utilize this data for analytics will refine the processes for population health management to deliver quality outcomes.

Once a partnership is established, the logistics of integrating data between the two parties in a secure environment becomes the focus. We live in an era that is heavily dependent on vendor solutions. This is predominantly done because, in most cases, it is more cost effective to purchase a specialty product than to try and create the vendor solution internally. The ability to integrate analytics between the provider and the health plan will open a door to provide new insight and pave the way for the future of healthcare.

Technology allows us to compute numbers, develop trends, and create strategies, essentially allowing us to receive impactful information quickly to help drive business decisions. Whether your company has built its own internal analytics or you utilize a vendor solution, each analytical platform is built differently, some more robust than others, but 2017 and 2018 will be the years where we will start to see how adaptable these platforms really are. The laws and regulations surrounding the need for analytics can change dramatically and without notification, especially under a new administration. The next four years with the Trump Administration will bring many healthcare changes to which analytics will have to adapt. The shining stars will be those who are able to easily adapt to the changes occurring quickly and accurately.

Focusing on key partnerships, data integration, solution adaptability, and innovative technology will help ensure your organization is utilizing the best healthcare analytics possible.

 

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Jessica Smith

About Jessica Smith

Jessica Smith is Vice President of Healthcare Analytics & Risk Adjustment Solutions at Gorman Health Group (GHG). In this role, she is responsible for the execution and oversight of risk adjustment consulting services for managed care, provider practice, and commercial market clients, and leading and integrating cross-functional teams to ensure superior performance outcomes related to risk adjustment operations. Read more

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