Profound, transformative challenges are making healthcare more accessible, improving the quality and efficacy of patient treatment, and revolutionizing the way valuable information is collected, exchanged and applied.
According to the Agency for Healthcare Research and Quality, there is a growing demand for healthcare data from many sectors. Key drivers for this demand have been surging interest in healthcare performance measurement and the information systems needed to aggregate, process and transmit healthcare data from which measures of healthcare quality may be developed. Healthcare is moving toward an evidence-based, decision-making model. Employers, consumers, payers and providers are demanding credible and actionable data. This is the time to move towards collaboration instead of competition.
It’s an exciting time for technology and innovation in the healthcare industry. The transformation of healthcare can be enhanced through information sharing and technology, leading to a focused, knowledge-based healthcare system. By providing data aggregation, data warehousing, performance management and analytics, healthcare executives can arrive at deeper insight. They can devise more effective strategies to increase quality and control costs.
Today, more data is available than ever before, but is this data transformed into actionable information? Is data being used to either reform the healthcare system or "out-think" your rivals? If not, you may be missing out on a powerful competitive tool.
Measuring value has become imperative to understand healthcare delivery in the U.S. Identification of high performing healthcare organizations, plans, networks and providers supports the focus on improvement. Purchasers, consumers and patients continue to demand increased transparency concerning the cost, quality and service of healthcare delivery. At the same time, expenditures on healthcare continue to escalate while evidence persists on avoidable costs and the gap between how medicine should be delivered and current practice. Measuring healthcare and providing incentives for high performance are critical tools in addressing differences in the cost and quality of care.
The Dialog on Quality and Transparency
There are many initiatives seeking to utilize a pool of rich data to address the difference in quality and cost. A step in addressing this issue is the perception of the providers (both hospitals and physicians). One continuing issue is the evaluation of provider quality when there are not enough occurrences for evaluation. With the creation of a multi-payer data repository, the ability to evaluate provider performance is not dependent on just one source of data.
Even Tricare for the retired military is focused on channeling to the high quality, low cost providers. The question remains--how can these providers be identified? No single entity--whether payer, employer or provider has sufficient data to grade broad networks. There are several data aggregation initiatives at the state and regional level. These varying initiatives are focused on organizations like Blue Cross and Blue Shield Association and employers.
The Louisiana Care Quality Forum has identified unwarranted variation from its data repository, which includes three of Louisiana’s major payers. According to Karen DeSalvo from Tulane University in an article in Healthcare Finance News, January 20, 2008, “One of the problems for us is we haven’t had a clear picture whether quality or cost problems are pervasive. We have a better picture from the multi-payers.”
Health plans have introduced high-performance networks to encourage use of top physicians in the area of quality and efficiency. Early adopters of these networks are large employers and, while others are interested, actual adoption has lagged. According to Health Systems Change, May 2007, enrollment in products using high performing networks is lagging due to the lack of objective evidence on the impact of service use, cost and quality.
There is often disagreement with the methodologies and lack of data. That leads to skepticism about these networks and the data used to create them. Due to these controversies, the growth of the high performance networks has not extended much beyond the large employers who were the key stimulus for their creation.
The key is to move toward uniform provider performance measurement. One plan executive, for example, expressed that physician quality determinations should not be based on data from one plan but rather on industry collaboration from both the private and public sector to make informed decisions on the quality of a practicing physician. In the eyes of the consumer, it would be damaging for different payers to have competing definitions of quality.
Benefits of Data Aggregation and Sharing
This joint effort of the aggregated data will create the first comprehensive and consistent source of data. This data will support measurement and apply both efficient technology and valid methodologies and be a significant contribution to performance measurement and transparency around healthcare and improving value.
Benefits through the data aggregation are many:
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- Greater confidence that the data is both reliable and balanced
- Identification of prevalent health problems and the ability to customize by client type, location and size
- Product development (expansion of business and modification of current geography and services) can be enhanced through pinpointing membership and service use beyond a single data source
- Enhanced data for benchmarking to assist in conducting comparative analyses
- Creation of a “multi-payer information highway” in place of current information silos
- Enhanced monitoring of healthcare trends and identification of potential epidemics, providing a head start in responding to bio-threats, pandemics or natural disasters (like Katrina).
- “One-stop-shopping” for consumer transparency through multi-payer data aggregation
- Confidence that individual proprietary contract rates and other intellectual property will not be put at risk with the data security disciplines that often occur with other data aggregation initiatives
- Information about the efficacy and safety of certain treatments and new medical technologies as well as emerging trends
- Create multi-payer and multi-employer disease registries
Physician Performance Management
- Access to more claims data on each physician allowing the ability to characterize physician-specific clinical and economic performance with greater statistical confidence and precision
- Credibility through a shared view, rather than a single payer or employer view of an individual provider for quality and resource efficiency
- Application of benchmarking tools for best practice for physician relations and data sharing, gap identification, consumer transparency and decision support
- Identification of treatment variation by region, state or individual provider
- Enhanced ability to apply clinical quality rule sets through evidence-based medicine
Predictive Modeling
- Ability to pinpoint trends through predictive modeling
- Strengthen the movement to greater healthcare transparency through unmatched detail about healthcare trends and best practices
Lack of Data Quality and Quantity
Sharing of data with other industry participants can ensure statistical validity. The application of provider quality rankings is just one application. The quality and cost of healthcare have suffered. Many quality and pay-for-performance initiatives address problem compliance rather than the quality of results. The problem lies in the lack of sufficient data to measure the quality of care.
It is difficult to determine data collaboration capabilities. Here’s what is needed:
- Experience with data standardization and enhancement--beyond just aggregating the data it is necessary to standardize across sources for valid analytics
- Analytical capabilities ready to perform business intelligence reporting
- Capacity to handle volume of data required for the initiative
- Ability to match members and providers across data sources, often without unique and consistent identifiers in the above sources
This joint effort--the collaboration of payer, employer and provider data--creates a comprehensive source to support performance measurement resulting in improved value for all.
Marybeth Regan, PhD, is an expert in disease and care management. She has written numerous articles on strategies for care and disease management. She may be reached at mb@yleen.com. Robin Randall-Lewis is an expert in Consumerism and Transparency strategy. She may be reached at robin.randall-lewis@reden-anders.com.
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