The move to a value-based payment system will force healthcare providers to utilize data in order to meet three challenges in this new reality. First, they must manage the deluge of data to support informed decision-making. Second, they must leverage analytics that look beyond the simple answers that point to a short-term shift in site of service to true care redesign. Finally, they must manage the balance between effective and efficient care as they implement change. The organizations that will thrive will be those that ask the right questions at the outset.
THE FIRST CHALLENGE – STOP DROWNING IN DATA AND START ACQUIRING KNOWLEDGE
We are seeing the emergence of sophisticated data processing power that can enable organizations to merge disparate data across administrative, clinical, ADT, financial, process and clinical sources. The race is on to find ways to capture data and to ensure that clinical information becomes computable. This move to embrace “big data” brings a new set of challenges big and small.
We have seen this in our own experience. In a recent study undertaken on behalf of a client comparing claims data to a nationally recognized surgical database, discrepancies in the frequency of reporting of information were found, as well as discrepancies with the definition of various data elements across data sets. Thus, we are advising provider organizations to take caution and fully understand the limitations of this data when utilized for predictive modeling and decision making.
In short, the value of big, integrated data will always be dependent upon asking the right questions and utilizing appropriate analytic tools to accurately direct strategic and clinical decision-making.
THE SECOND CHALLENGE: MOVING BEYOND SHIFTING SITE OF SERVICE TO INTEGRATED CARE REDESIGN
A focus on shifting the site of care alone will deliver cost efficiency but can increase the risk of adverse clinical outcomes if appropriate care isn’t factored in. A focus on care redesign must begin with a data-driven understanding of the risk-profile of the population served, so that for a given population a change in process leads to higher quality and safer care.
The rapidly advancing era of bundled payments, accountable care, and public reporting of outcomes means that a common ground must be achieved so that both physicians and hospitals can achieve their desired goals. It will be this relationship that will likely be the most important in resolving the issue tension in the delivery of effective and efficient care.
Prudent organizations will use data to define appropriate decision making as well as monitor outcomes in order to recognize when efforts at maximizing cost savings or process efficiency begin to impact the effectiveness of care.
THE THIRD CHALLENGE: FINDING THE CONFLUENCE BETWEEN EFFICIENT AND EFFECTIVE CARE
Where should providers shift their efforts to ensure that they are prepared to measure what matters in the evolving payment system? Health care providers may be tempted to focus on utilizing the plethora of performance level measurements that have proliferated under a variety of quality reporting systems. Unfortunately, this may induce greater complexity and add little value at the level of enterprise decision making. After all, too many metrics can obscure a trend rather than reveal it.