No other industry has undergone such significant and tumultuous transformation over the past decade as healthcare. The sea-change spawned by the Affordable Care Act, the transition away from fee-for-service toward value, and the proliferation of digital healthcare innovations have resulted in major steps forward for healthcare. But like all change, disruption is hard and there is still so much more to do. And, there’s no slowing down in sight with the ushering in and evolution of big data innovations such as machine learning and Artificial Intelligence on the horizon.
With the fundamental changes to healthcare delivery models and technological advances, providers are more data-driven than ever before. However, while we’ve made a lot of progress, the proliferation of provider networks such as Accountable Care Organizations and Clinically Integrated networks continue to drive the need for more comprehensive data integration so that data analytics can be leveraged to inform more efficient processes for delivering high-quality patient care.
What lies ahead? Here are five key trends that I see shaping value-based care in 2019:
• Investment in Value-Based Innovation
Healthcare organizations are shifting from strict fee-for-service reimbursement models to value-based models. In fact, the adoption of value-based care is expected to account for 59 percent of health care payments by 2021, according to Aetna. Analytics play a vital role in value-based contracting, so organizations will be eager to implement solutions that can leverage health care data and determine where opportunities exist, whether that’s improving patient outcomes, achieving success in quality measures, or reducing the total cost of care.
• Prioritizing the Aggregation and Integration of Data Across Sources
Provider networks now span wider geographies and more diverse practice types. That means there are a variety of different data sources—clinical, claims, socioeconomic, scheduling etc.—to integrate in order to produce the richest data sets and the most meaningful analytic insights. Remember: The analytics you run and the conclusions you draw will only be as good as your data. Sophisticated population health tools can help break down silos and ease the pain of data aggregation, ensuring that the data is clean and that there is a single “source of truth.” Ultimately, the goal is to provide the best care possible in a cost efficient manner. Comprehensive, high quality care requires providers to have a holistic view of the patient’s history and their upcoming scheduled visits at their fingertips to easily identify gaps in care that need to be addressed.
• IT Skills Beyond Coding and Data Reporting
There is a growing need for strategic, big-picture thinking as health care organizations become more complex and practice value-based care delivery. Healthcare data analysts will need to understand all the levers of value-based contracts including which programs or strategies will be most impactful when it comes to achieving success across the various quality measures. Running data and pulling reports is no longer enough. Healthcare data analysts will be increasingly charged with turning data into valuable, actionable direction to help health care providers participating in alternative payment models deliver the best care possible while simultaneously ensuring better patient and financial outcomes. Providing focused analytics with clear action steps to achieve desired outcomes is key.
• More Machine Learning for Health Systems
Healthcare organizations used to be focused on analyzing lagged claims information and historical trends to make assessments on financial risk planning. However, this is a limited strategy because it is not the holistic view of the data needed to make the leap from predictive to prescriptive analytic insights. But technical advancements like machine learning and data mining now enable analysis that can be used to predict both patient and financial outcomes, and other more sophisticated applications for clinical decision support, disease management, and medical costs assessments. It’s about providing prescriptive analytics that can be used to predict and guide which next steps are best for providers and practices to drive the best outcomes for the patient as well as financial performance in the value-based contract. This is the real value to be found within the data.
• New Partnerships between Clinicians and those Working in Finance
Effectively managing risk in value-based contracts involves robust communication between clinical and financial leaders within a healthcare organization. That’s why it is becoming more and more important for providers and other network leaders to meet regularly to report progress, gather feedback, and assess performance against shared goals. Clinicians must be able to identify opportunities to achieve the best patient outcomes while containing costs. Meanwhile, financial leadership must understand the incentives to providers and hospitals for participating in value-based contracts and how they impact fund flows. Data analytics can aggregate this data and flag opportunities for collaborative solutions.
Value-based care is driving efforts to rein in the growth of healthcare costs and improve patient and financial outcomes. By embracing these trends in the year ahead, healthcare leaders can advance a more holistic approach to patient care while enhancing efficiencies and reducing costs.