Value-based care analytics: Leveraging data insights to enhance reimbursement and quality

By nThrive | Posted: 04/11/2018

There’s an abundance of data permeating every nook and cranny of the health care continuum. In his ACC 2015 presentation on big data, James Tcheng, M.D., FACC, FSCAI, of Duke University, North Carolina, explained that a typical tertiary care hospital generates about 100 terabytes (TB) of data per year whereas the United States Library of Congress is estimated to contain only about 10 TB of text data. This simple comparison illustrates the enormous opportunity health care organizations have to tap into this treasure trove of data, reshaping health care through the creation and enhancement of value.

In today’s value-driven reality, government legislation such as the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) is shaping the course with new value-based reimbursement (VBR) payment models, linking quality performance metrics to provider reimbursement. Health care organizations are under immense pressure to adapt to VBR and quality-based incentive models to replace fee-for-service models.

The ever-evolving quality reimbursement models provide financial incentives to health care providers to maximize value for patients while achieving the best outcomes at a lower cost. The new rules are compelling health care organizations to look to their data for opportunities to offset potentially negative financial consequences resulting from the transition from fee-for-service care.

Data Insights Direct Value

The concept of incorporating data analytics across the health care continuum to drive value is new to many health systems. But to improve outcomes and reduce cost, health care leaders must set aside long-established mind-sets and welcome new approaches. Investing in a strong data analytics strategy will enhance quality across their organization, garnering success under the value-based reimbursement models of today and the future.

Organizations that achieve the highest level of reimbursement are those that integrate the universe of data into a single dataset and systematically monitor, pinpoint and act upon the performance opportunities revealed through deep, advanced analytics. Health care providers who are successful under value-based reimbursement realize that an effective, well-executed data analytics strategy has the power to drive success.

The quantitative methods of analytics are vital to both the creation and enhancement of value across the health care delivery system. Data analytics helps physicians identify and understand how and when their health care decisions impact cost, profitability and care quality, while learning where they stand in relationship to their peers. This illustrates how those who exceed the peer performance benchmarks will receive greater compensation.

Types of Data Analytics

As health care providers work feverously to identify and adopt both short- and long-term strategies to ensure value-based reimbursement (VBR) success, it is important to have a clear understanding of the basic types of data analytics and insights garnered by each. Your data strategy needs to guarantee you get the most from data, making it available and flexible so it can be beneficial now and in the future.

You are free to choose what type of analytics you employ but keep in mind, health care data is and will always be in a constant state of flux, so engaging health-care specific analytics that incorporates flexibility and scalability is vital to a successful transformation to value. According to McKinsey & Company data analytics could account for an estimated $300 to $400 billion in cost savings – upwards of 17 percent of the total national health care expenditure, thus illustrating the importance of a solid analytics approach.

Reactive Analytics Approach

Descriptive Analytics

Descriptive analytics describes the past and answers the question, “What happened?” This type of analytics identifies past behaviors and helps us understand the possible influence the past might have on future outcomes. Descriptive analytics can be employed to describe at an aggregate level what is going on in different areas of your organization such as financial, operational or clinical reports that provide historical insights. Although a reactive analytics approach does provide value, it may not provide all the insights necessary to develop and execute a winning value-based reimbursement strategy.

Proactive Approach

Predictive Analytics

Predictive analytics predicts or forecasts what might happen in the future by utilizing historical data. This type of analytics is based on probabilities, identifying patterns in historical data and estimating future outcomes based on statistical techniques. Organizations use predictive analytics to identify what is likely to happen, what is the best activity or what performance measures to address, all based on historical significance relative to the forecast. As health care providers pursue optimum quality performance outcomes, predictive analytics can play a significant role in predicting the future and guiding performance in the best direction.

Prescriptive Analytics

Prescriptive analytics prescribe or advise possible actions that can be taken to resolve a future issue. These analytics go further than descriptive and predictive analytics by attempting to tell you what will happen and making recommendations for the best actions to take. Prescriptive analytics is by far the most complex and sophisticated and, if implemented successfully, can have the biggest impact to you value-based care strategy and company’s bottom line.

Make data analytics your most strategic asset

Data analytics powers faster and more sophisticated decision-making capabilities when it comes to value-based care. Data-driven organizations take a holistic approach to health care by aligning their business strategy to how they will use cross-continuum data insights to create value throughout the organization. Make data analytics your most strategic asset by learning from the past and planning for the future.

To learn how nThrive Analytics can help your organization identify performance improvement opportunities across the care continuum, go here.

To learn how we can help you find success under the MACRA Quality Payment Program, go here.