“Big Data” has become a key driver of technological innovation throughout the healthcare industry for the last few years. As data and software vendors begin to roll out new products, the focus must shift towards the industry’s stakeholders and how they can use Big Data to their collective benefit.
Since 2010, over 200 HealthIT firms have developed tools and products to make better use of available healthcare information. Much of this innovation has been driven by healthcare stakeholders’ increased demands for a system that can accommodate the data that will emerge from the recent health reforms and provisions under the PPACA.
The data collected under the new healthcare landscape will be useless however, unless key industry stakeholders realign their goals and expectations. With Big Data becoming a critical factor in accessing patient and clinical data as well as analyzing healthcare costs and spending, the entire continuum of care must be addressed by the efforts of all parties involved. Determining the right care, provider, value, innovation and lifestyle can only be achieved by effectively utilizing the data available to providers, payers and patients.
Capturing the value from Big Data will require industry proponents to develop relationships and partnerships with other organizations that may have traditionally been competitors or worked towards achieving different goals. These ventures could include:
- Payers working closely with providers on restructuring claims processing and reimbursement procedures.
- Pharmaceutical and device manufacturers collaborating with payers and providers to determine success rates of medicines and devices; analyze costs and spending; and observe patient behaviors.
- Employers and their employees sharing patient information with payers or TPAs and the medical providers serving them to gain the most out of their insurance coverage and benefits plan.
Big Data Priorities for Payers & Assistance Companies
Shifting focus towards Healthcare payers and assistance companies, many may find Big Data will become beneficial in selecting the most effective treatments, locating the most successful and cost-efficient providers, and identifying high-risk patients or complex medical cases – all while remaining HIPAA compliant.
Building new basic data-analytics engines to leverage existing data more effectively.
- Comparing the performance of both providers and networks; this information can be used during rate negotiations and when investigating the potential impact of new risk-sharing arrangements.
- Isolating outliers within the provider network and determining the factors that are driving their performance; if necessary, payers may need to consider changes to their network strategy or member incentives to direct patients to better providers.
- Sharing performance data, when possible, with clients and members to encourage greater use of the best-performing providers.
Ensuring data-driven decision making and effective data capture
- Defining value drivers for members, as well as the member behaviors and choices that drive value for payers.
- Building clear analytical methods to evaluate expected member value and actual performance.
- Building A/B testing capabilities to compare efficacy of messaging and explore alternatives to member or provider outreach campaigns.
- Identifying resource-intensive workflows and business processes that could be made more efficient through big data, such as provider authorization, evaluation of claims accuracy and auto-adjudication of claims.
Isolating the most important practices that improve the cost of care and partnering with providers and manufacturers to implement those practices more broadly.
- Assessing trends related to various cost-drivers for patient care, including those that appear unusual because they deviate from expectations or from levels reported by peer organizations; for instance, payers should identify providers, health conditions, and patient types where costs have been much lower than expected.
- Evaluation total costs for the highest performers, including those related to readmission administrative tasks and laboratory work.
- Quantifying the metrics that define best-in-class performers, initiating programs to communicate them, and creating incentives to meet these standards.
Ultimately, payers and assistance companies will have access to an entirely new set of complete data. For example, access to claims history and clinical data can eliminate the possibility of unnecessary treatments, and help select the most effective treatment for the patient. Furthermore, with adequate data, insurers could evaluate the possibility of implementing value-based reimbursement incentives to encourage high quality care delivery for provider and health choice for consumers.
Big Data will help generate an effective workflow throughout the entire healthcare landscape. What will this require? Participation from all healthcare stakeholders and an aligned set of industry goals to accompany the transition to Big Data.
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