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A Focus on Risk, Quality & Network Optimziation

News  |  By Rose Higgins  
   July 24, 2017

As provider organizations continue toward value-based outcomes and reimbursement, the risk is too high to rely on assumptions. Providers must take insight-driven actions around key objectives such as managing risk, improving quality and provider network management.

As provider organizations continue the journey toward value-based outcomes and reimbursement, such as MACRA, they face many critical decisions that will impact their business and patient outcomes. The risk is too high to rely on assumptions and interpretations. Instead, providers must be able to take insight-driven actions around key objectives such as managing risk and improving quality and provider network operations - areas that can significantly impact cost and quality outcomes.

Understanding best practices to using data and analytics to face these challenges head-on can be a critical tool to drive value-based contract performance, as well as deliver key insights needed to successfully manage at-risk contracts and populations. 

As an industry, we understand a tipping point is on the horizon. The question to ask is: Will your healthcare organization be ready for it?

By the year 2020, value-based care is expected to be the dominant payment model, according to a survey conducted by Lazard. The upshot? Healthcare provider organizations will have to deal with new realities – by implementing new strategies.

Below is a quick rundown of what might come into play as the transformation takes hold.

4 New Realities in a Value-Based World

1. Healthcare networks will need to focus on efficient care delivery. Successful networks are likely to include tightly aligned providers. And care will be rationalized among lower cost alternate care sites such as ambulatory facilities, pharmacies and urgent care centers.

2. Healthcare delivery systems will increasingly compete on quality and cost. And, to succeed, advanced analytics will be needed to understand variation and improvement opportunities. Greater efficiency will be achieved by standardizing care across settings and addressing variation while managing a population’s health.

3. Care delivery is best developed and delivered by teams with a focus on care coordination.

4. Value based care is here to stay. With MACRA, MIPS and other value-based payment programs, providers have started their adoption journey and agree that reducing healthcare costs while ensuring quality is the only viable option.

6 Strategies for Success

1. Understand the data that your organization collects. Having a data strategy that centers on using impactful data vs. big data (all data). Trend identification is the key.

2. Prepare to rely more heavily on layering data (clinical, financial, behavioral, etc.). Providers should pair the right data together in order to understand where and how care is being delivered – and the nature of any care gaps that exist across care networks. As such, providers will be able to target and improve overall care delivery and quality.

3. Use predictive and prescriptive analytics to transform data into impactful intelligence. Organizations will need to not only understand what happened, but also predict what will happen in the future and what the best strategy is to reach desired outcomes.

4. Drive quality improvements. No matter where providers are on their journey toward value-based care delivery, all will need to focus heavily on delivering higher quality care using the most efficient and effective methods. Providers also must meet quality measures in order to maximize performance in value-based contracts.

5. Manage population and financial risk. Understand where risk exists across your network and identify high ROI opportunities to reduce that risk.

6. Optimize provider networks. Insights into issues such as referral patterns and leakage can help networks improve efficiency, reduce costs and manage provider quality performance.

The adoption of value-based payments is happening now and accelerating rapidly. It is our observation that payers, providers and consumers are transitioning to these models, but each at varying speeds. Regardless of their location on this path, healthcare organizations need to focus on using data and analytics as a tool that will guide them in meeting their quality-based goals.

In summary, the industry if finding that all healthcare organizations have will be focusing on using data and analytics as a tool that will guide them in meeting their quality-based goals.

President, North America
SCIO Health Analytics

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