The Affordable Care Act (ACA) produced a wealth of data from its first two years in operation. Health actuaries voraciously consumed that data, using predictive modeling techniques to solve healthcare industry problems that have never been seen before. While we don’t yet know how the ACA may change, I know actuaries will find solutions, because we thrive in the realm of the uncertain.
Actuaries have always been in the business of data. Centuries ago the work involved scanning clerical ledgers to create the first mortality tables. Today, human activity, including healthcare, is far more complex. Every two days, we create more data than was created from the dawn of civilization through the year 2000.
A significant portion of my recent work has involved studying ACA data, particularly deconstructing a health plan’s performance using the prism of risk adjustment.
Risk adjustment used to be a niche on the spectrum of a healthcare actuary’s work. However, since the ACA risk adjustment program is now a permanent fixture – for the time being – in commercial individual and small group markets, it is the focus of many actuaries’ every day work. Risk adjustment involves adjusting a health plan’s revenue based on a measure of morbidity of the average member enrolling with the plan. It aims to mitigate incentives to select low-risk populations, and instead re-focus the basis of competition on other factors such as quality, efficiency, and benefits delivered.
The program presents a great opportunity for actuaries to apply predictive modeling concepts on large scale data to deliver actionable insights to clients and employers. From the predictive modeling work, actuaries have learned that risk adjustment renders seemingly intuitive notions of health plan performance and profitability rather meaningless. For example, sicker and costlier individuals may have threatened a health plan’s viability in the past. But that may not necessarily be the case going forward.
As the healthcare industry continues to become simultaneously more patient-centered as well as more performance-oriented, healthcare organizations and biotech companies alike are taking a closer look at how they can improve clinical quality measures. Although the industry has been widely criticized for a lack of meaningful, uniform industry standards, there’s no denying the link between understanding clinical effectiveness and improving overall patient outcomes. To truly assess quality, organizations need to make sense of the myriad of real-world evidence (RWE) data they already have at their fingertips.
RWE data enables a comprehensive understanding of data physician utilization patterns, patient treatment options, drug comparative effectiveness and more. However, the current, typical approach to RWE – a vast array of siloed databases, services-dependent, with access restricted to just two or three “power users” – has shown to be utterly ineffective. In fact, market estimates suggest big pharma spends $20 million dollars on average annually on RWE, but they are still no closer to fully understanding the real-world impact of pharmacologic and non-pharmacologic treatment on patients.
The problem is not a lack of data, but rather an inability to access RWE data quickly by the very people who are best suited to make sense of the information. Current strategies and tools simply cannot access, analyze, and deliver insights quickly enough for the information to be of use to the organization. However, new approaches to data analytics are ready to eliminate these historical roadblocks and transform RWE data into meaningful insights that can help measure clinical quality effectiveness.
Leveraging cloud-based analytics is one such approach. These solutions are increasingly becoming a critical tool to uncover how quality care initiatives are progressing. Unlike tools of the past, cloud-based offerings can provide rapid access to the data and derived insights in the language that resonates most when measuring quality. For instance, delivery via the cloud enables the real-time scalability necessary for RWE data. As the variety, volume and velocity of RWE data continues to increase, on-premises solutions simply cannot scale quickly enough to contend with terabytes of data and the analytic demands of its users.
Guest post by Nora Lissy, RN, BSN, MBA, director of healthcare information, Dimensional Insight.
A recent report from Research and Markets predicts that the healthcare data analytics sector will grow to more than $34.27 billion by the end of 2022. This is indicative of how hospitals and health systems are realizing the intrinsic value in an analytics capability—which can be leveraged for everything from capturing information to interpreting the data—to make more informed care decisions. From a provider standpoint however, many physicians are still struggling to close the gap between turning data insights into actionable care improvements. For example, looking at a data set of former pharmaceutical plans for patients with asthma and using the information to make a more informed prescribing decisions for a current patient.
So what can healthcare organizations do to help bridge the divide between the clinical staff and the IT department to make it easier for doctors and clinicians to see how analytics can be applied in their day-to-day care routine? To start, they need to identify which members of their clinical staff have a “data mind” and can easily see how data can be turned into care improvement. For example, looking at an analysis of a hospital’s patient care transitions and adjusting patient handoffs to be more streamlined across departments. A person in this role can communicate to both the clinical and IT sides of the house why data needs to be presented in a certain way and where care adjustments and enhancements can be made.
So how can you find this diamond in the rough who has the ability to turn providers’ “Medical Minds” into “Data Docs” of tomorrow? Here are three tips to help determine who the best person at your organization would be to help fill these shoes:
Who is your organization’s “go-to?”
Who is the one person in your organization/department who everyone goes to with questions? It can be anything from a question about a schedule change or process to a new patient’s medication history. In many cases, this doesn’t even need to be someone from the clinical side or from the IT side. It simply should be someone who has a global view of the organization and who is familiar with the clinical side and has an understanding of what needs to happen on the technical side.
Who has good business intuition?
Someone who has a natural knack in the business world also typically has a data-oriented mindset. This is someone who is not afraid to question the reasoning behind certain recommendations and processes. This is not to say that this individual is counterproductive, but instead is the problem solver. Much like the organization’s go-to contact, this person also sees the full organizational picture rather than just through the lens of the department that they work for and are instilled with ability to translate the business and operational needs into the technical needs.
The health IT revolution is here and 2016 will be the year that actionable data brings it full circle.
Opportunities to achieve meaningful use with electronic health records (EHRs) are available and many healthcare organizations have already realized elevated care coordination with healthcare IT. However, improved care coordination is only a small piece of HIT’s full potential to produce a higher level synthesis of information that delivers actionable data to clinicians. As the healthcare industry transitions to a value-based model in which organizations are compensated not for services performed but for keeping patients and populations well, achieving a higher level of operational efficiency is what patient care requires and what executives expect to receive from their EHR investment.
This approach emphasizes outcomes and value rather than procedures and fees, incentivizing providers to improve efficiency by better managing their populations. Garnering actionable insights for frontline clinicians through an evolved EHR framework is the unified responsibility of EHR providers, IT professionals and care coordination managers – and a task that will monopolize HIT in 2016.
The data void in historical EHR concepts
Traditionally, care has been based on the “inside the four walls” EHR, which means insights are derived from limited data, and next steps are determined by what the patient’s problem is today or what they choose to communicate to their caregiver. If outside information is available from clinical and claims data, it is sparse and often inaccessible to the caregiver. This presents an unavoidable need to make clinical information actionable by readily transforming operational and care data that’s housed in care management tools into usable insights for care delivery and improvement. Likewise, when care management tools are armed with indicators of care gaps, they can do a better job at highlighting those patients during the care process, and feeding care activities to analytics appropriately tagged with metadata or other enhanced information to enrich further analysis.
Filling the gaps to achieve actionable data
To deliver actionable data in a clinical context, HIT platform advancements must integrate and analyze data from across the community—including medical, behavioral and social information—to provide the big picture of patient and population health. Further, the operational information about moving a patient through the care process (e.g., outreach, education, arranging a ride, etc.) is vital to tuning care delivery as a holistic system rather than just optimizing the points of care alone. This innovative approach consolidates diverse and fragmented data in a single comprehensive care plan, with meaningful insights that empowers the full spectrum of care, from clinical providers (e.g., physicians, nurses, behavioral health professionals, staff) to non-clinical providers (e.g., care managers, case managers, social workers), to patients and their caregivers.
Guest post by Mohd Haque, vice president and global business head, healthcare, Wipro Technologies.
Population health management (PHM) isn’t just the latest buzzword. Or a new initiative mandated by the Affordable Care Act. Implementing a successful PHM program requires a complete shift in mindset from volume healthcare to value-based and outcome-based. PHM can’t be something that your healthcare facility “does,” but it must become the cornerstone of everything related to how your facility practices medicine.
Although the shift in perspective is the first step, it is essential to arm yourself with Population Health Management IT tools as well. According to 26th Annual HIMSS Study, half of the respondents (51 percent) have improved PHM through IT tools with only 38 percent saying that their organization was using specific Population Health Management tools.
By using big data analytics, EHR integration, IT infrastructure and security as part of a PHM program, providers can ensure patients that need high levels of care aren’t overlooked and the lower risk patients don’t get unnecessary care. This will in turn increase quality of care while saving money on interventions needed for low risk patients.
What are the Components of Effective PHM Program?
Since PHM is such a large shift, it is important to know exactly how to go about creating an environment that focuses on outcomes instead of volume. Population Health Alliance recommends the following four components to a PHM program:
Assessment – Evaluate each patient’s health and assign patients to a risk group (high to low)
Stratification – Provide the same interventions for everyone in the same risk group
Person-Centered Intervention – Provide interventions based on each specific patient’s needs, including community health research
Impact Evaluation – Determine the impact of interventions for each risk group as well as each individual patient
However, you can’t simply change the process without changing how each person on the team views healthcare and their patients. It must be a fundamental shift in your facility from the receptionist to the department chief.
GenoSpace has built a comprehensive platform for genomic and other biomedical data. Its serves research, clinical development, pathology and clinical care customers who work with high-dimensional genomic and other biomedical data.
At GenoSpace, we are digital architects of genomic medicine. GenoSpace has built a comprehensive platform for precision medicine to enable interpretation, analysis, reporting and collaboration on high-dimensional genomic and other biomedical data. With specific applications supporting research, development, pathology and clinical care, many of the most advanced precision medicine organizations are powered by GenoSpace.
GenoSpace has built a comprehensive software platform for genomic medicine. The company leverages a single storage and security platform to deliver a variety of applications and services including reporting, population analytics, clinical trial matching, interactive physician and patient portals, and patient communities. GenoSpace specializes in data integration, modeling, analysis, interpretation, visualization and collaboration. GenoSpace applications serve users at laboratories, health systems, and organizations engaged in research and clinical development, as well as patients.
GenoSpace was founded by John Quackenbush and Mick Correll in 2012 after they realized existing platforms for analyzing genomic information could be greatly improved. John is board chair and Mick is chief executive officer.
John received his PhD in theoretical physics from UCLA in 1990. Following a physics postdoc, he was awarded a 1992 NIH Special Emphasis Research Career Award to work on the Human Genome Project. After two years at the Salk Institute and two years at Stanford University, he moved to The Institute for Genomic Research, pioneering gene expression analysis. He joined the Dana-Farber Cancer Institute and Harvard School of Public Health in 2005 and works on reconstruction of gene networks that drive the development of disease. He received a 2013 White House Open Science Champion of Change award for his work on facilitating genomic data access.
Mick’s more than 15-year career has tracked the path of genomics from basic research to clinical care. Over this time he has held leadership positions in academia and industry, and has developed informatics solutions for pharma/biotech R&D, ag-bio, and academic, government and community healthcare providers. Prior to launching GenoSpace, he and partner John Quackenbush established the Center for Cancer Computational Biology at the Dana-Farber Cancer Institute. Mick began his career at Lion Bioscience Research Inc. and UK-based informatics provider InforSense. Mick earned a BS in Computer Science and BA in Molecular Biology from the University of Colorado at Boulder.
Market opportunity (in your particular space–numbers, competitors, etc. are helpful)
The market for interpreting and analyzing molecular and other biomedical data is a multi-billion dollar component of the broader molecular diagnostics and applicable life science research markets—each of which represent tens of billions of dollars per year. GenoSpace’s target customers are innovators in lab medicine, hospitals and health systems, and research and clinical development organizations. While there are several competitors for individual offerings provided by GenoSpace, the company is unmatched in its cloud-based architecture, comprehensive suite of offerings and experience delivering those offerings to real customers.
What do Disney, Apple, Southwest Airlines, Mayo Clinic, USAA, Amazon, Pandora, and Kaiser Permanente have in common? They all sell the same thing.
Whoa! That’s crazy talk. What’s that you say?
Yes, each of these organizations knowingly and deliberately differentiates and competes on customer experience. In fact, each one delivers the best customer experience in its respective industry, as measured by Net Promoter Scores.* Whether delivering immersive entertainment, personalized radio or healthcare, these companies make an emotional connection and engage their customers in extraordinary ways.
Within healthcare the importance of the patient experience cannot be overstated. Our personal health and well-being is synonymous with happiness and is manifest in our personal experience. For many of us, being sick, in pain or in fear for our life (or the life of a loved one) tends to heighten our perceptions and amplify every experience. It’s during such times when a kind word can seem like a grand benevolence, and the slightest oversight feels like a cruel insult. As such, providers should invest as much energy in delivering the best possible customer experience as they do in delivering safe and effective treatment.
Patient satisfaction is not patient experience
The Beryl Institute defines patient experience as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” Unfortunately, the standard method for measuring patient perceptions about healthcare is a collection of survey questions. Don’t get me wrong; we need a consistent method for assessing patient perceptions to make apples-to-apples comparisons between organizations. The Consumer Assessment of Healthcare Providers and Systems (CAHPS**) survey offers healthcare consumers and financers just that – information by which to make such comparisons. However, the subjective survey data alone is insufficient for providers to fully comprehend and then systematically improve patient experiences.
I won’t belabor the difference between patient satisfaction and patient experience here, but I will draw your attention to Fred Lee’s work on this subject. Lee aptly compares Disney with American hospitals in his best-selling book If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently. I strongly encourage you to invest 17 minutes watching his funny and exceptional TEDx talk on the fundamental difference between patient satisfaction and patient experience.
The International Data Corporation (IDC)Health Insights, as it reported on its webinar, “IDC FutureScape: Worldwide Healthcare 2015 Predictions,” highlights the healthcare predictions for 2015 based on the IDC FutureScape report, which provided organizations with insight and perspective on long-term industry trends along with new themes that may be on the horizon.
As healthcare costs rise, operational inefficiency will become critical at 25 percent of hospitals resulting in the development of a data-driven digital hospital strategy requiring budget in 2016.
Also, the following are several more predictions based on the firm’s insights and research:
By 2015, 50 percent of healthcare organizations will have experienced one to five cyber attacks in the last 12 months with one out of three attacks deemed successful requiring healthcare organizations to invest in a multi-prong security strategy to avoid disruptions to normal operations and incurring fines and notification costs.
Driven by the increased pressure to improve quality and manage costs, 15 percent of hospitals will create a comprehensive patient profile by 2016 that will allow them to deliver personalized treatment plans.
By 2020, 80 percent of healthcare data will pass through the cloud at some point in its lifetime, as providers seek to leverage cloud based technologies and infrastructure for data collection, aggregation, analytics and decision-making.
As a result of an increased focus on improving the consumer experience, 65 percent of consumer transactions with healthcare organizations will be mobile by 2018, thus requiring healthcare organizations to develop omni-channel strategies to provide a consistent experience across the Web, mobile and telephonic channels.
To control spiraling healthcare costs related to managing patients with chronic conditions, 70 percent of healthcare organizations worldwide will invest in consumer-facing mobile applications, wearables, remote health monitoring and virtual care by 2018, which will create more demand for big data and analytics capability to support population health management initiatives.
Building on continuing technology innovation and the increasing use of knowledge-based workflows and actionable analytics, more than 50 percent of big data issues will be reduced to routine operational IT by 2018, reducing the need for specialized IT resources to support big data.
With increased dependence on external partners for outsourced services, more than 50 percent of health and life science buyers will demand substantial risk sharing by 2018 to ensure that service providers recognize their growing role in the process and delivering added revenues to high performers at the expense of satisfactory or lesser performers.
As a result of increased pressures to deliver better outcomes of care more efficiently, payers implement newer reimbursement models for 35 percent of their payments to providers in NA and EU within the next 36 months resulting in related investments in quality measurement, payment and billing systems.
By 2020, 42 percent of all healthcare data created in the Digital Universe will be unprotected but need to be protected, as use of data and analytics continues to proliferate and more stakeholders are involved in delivery of care.
Guest post by Michelle Blackmer, director of marketing, healthcare, Informatica.
Several weeks into the New Year, our fitness resolutions are still top of mind. Whether tracking calories or steps, we are asking ourselves questions like “how many pounds have I lost?”, “how many calories did I eat?” and “how many steps did I take?” To take the guesswork out of it and to hold ourselves accountable, many of us put a Fitbit, Nike Fuel or Jawbone on our wish lists. Our physical fitness has become data-driven; these devices create data that provide insight, enable us to visualize patterns and generate millions of bytes of data, which helps account for the anticipated annual 40 percent growth in big data. However, this is only the tip of the iceberg for data-driven healthcare.
Health information leaders must continue to assess their business resolutions and take stock of their healthcare data fitness. This is especially important since an alarming 40 percent of healthcare executives gave their organizations a grade of “D” or “F” on their preparedness to manage the data deluge. What’s more is that none felt their organization deserved an “A.”
Successful transformation to value-driven care requires an investment in enterprise information management. However, healthcare organizations are tightening their belts and bracing for the hit to their bottom lines in response to the health reform law that took effect on January 1, 2014. Instead of scaling back, healthcare organizations must invest in the fitness of their data. After all, if the wrong data is analyzed (i.e., inaccurate, incomplete, missing or even unnecessary), organizations are going to make the wrong decisions. What is the cost of making the wrong decision?
Assess your data fitness. Ask yourself the following questions:
Guest post by Jonathan Zimmerman vice president and general manager, Clinical Business Solutions, GE Healthcare IT.
With key deadlines looming, 2014 will be a critical year for the healthcare industry, one marked by important industry milestones and advances. As ICD-10 implementation and meaningful use Stage 2 attestation approach, many are saying we have reached healthcare’s tipping point – where first of its kind opportunities for collaboration and innovation intersect with challenging regulatory standards and population health demands. In order to better facilitate these updates and solve potential market challenges, healthcare providers will need to blend innovative technological solutions with current operational systems.
As the industry evolves, we anticipate three key opportunities for 2014.
#1: Smarter Collaborations
New industry partnerships and alliances are being created to collectively address standardization and implementation. Healthcare IT organizations are working to adopt common standards and protocols to provide sustainable, cost-effective, trusted access to patient data. Payers and providers are coming together to ensure healthcare providers are setup up for success. Regulatory agencies, manufacturers and providers are working diligently to approve more devices, streamline communications and update payment codes in time for ICD-10 implementation. We are also seeing CIOs/CTOs work closer than ever before with physicians in order to reap the benefits of incentive driven initiatives like meaningful use Stage 2.