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eQHealth Blog

Helping Healthcare Executives Navigate Treacherous Waters

During the “Age of Exploration” it was the leaders of those expeditions – Columbus, Magellan, Cortes, Cabot, etc. – who received the bulk of the recognition and the glory. Not to mention the monetary rewards.

But without the behind-the-scenes efforts of their navigators, those missions through treacherous and largely uncharted waters would likely have ended in disaster instead.

Executives at payers and providers find themselves in similar circumstances to those early explorers. Thanks to electronic health records (EHRs), Internet of Things (IoT)-enabled devices, patient-generated data, claims data, and the ready availability of demographic, sociographic, and social determinants of health (SDoH) information, they are facing an ocean of information the likes of which the world has never seen.

The challenge now is how to navigate through that ocean to ensure they find something of value on the other side. The right business intelligence (BI) software and healthcare analytics will act as that navigator, avoiding the shipwrecks of well-intentioned but abandoned projects to deliver insights that open up a whole new world of opportunity to payers and providers.

Proper provisioning

Like any long and arduous journey, it starts with properly provisioning the effort by ensuring healthcare executives can draw, use and trust data from multiple disparate sources. This process requires implementing a reliable clinical integration framework that supports integration and secure data exchange with a broad range of providers, health information exchanges (HIEs), payers, pharmaceutical companies and other entities.

The framework must then be able to normalize and synthesize the data so it can be used in BI and healthcare analytics applications. It must become the single, trusted source for everything that is to come.

Beginning the journey

With the framework in place, healthcare organizations are ready to assess the risks within their current operations as well as begin exploring wider blue ocean strategies. One critical example, especially as healthcare shifts toward value-based care, is using BI and healthcare analytics to risk-stratify the entire patient/member population to understand where the most money is being spent right now – and where it’s likely to be spent in the future.

Research has long shown that 5% of patients/members account for 50% of the spend on care, and true to the Pareto Principle 20% of patients/members take up 80% of the spend. Using BI and healthcare analytics to discover who those 5%/20% are, and which ones are likely to join them in the future, can help healthcare executives develop plans and implement programs to address those risks and bend the cost curve in their favor.

BI and healthcare analytics can also be used to dive deeper to determine which patients/members are most likely to improve their health outcomes by being enrolled in a care coordination or chronic condition management program. These analytics will not only look at their risk levels but other factors such as their propensity to follow a care plan based on their own history, SDoH issues and demographic/sociographic data from others who are similar to them.

With that information in-hand, healthcare organizations will gain a better understanding of where to direct their limited resources to drive the best outcomes and generate the strongest ROI. They will also have the ability to plan more effectively for the future – not just next year, but several years out.

All hands on deck

The other key to using BI and healthcare analytics effectively is to make sure they’re easy for business owners to access and operate. While some more sophisticated inquiries will require Ph.D.-level thinking, many of the answers healthcare organizations need are far less complex.

To maximize the value of the investment, business owners should be able to ask and answer many questions that directly affect their departments and staffs. This capability will enable the organization to make quick course-corrections as-needed rather than ending up on the rocky shoals of bad business decisions.

Reaching new worlds

The ocean of healthcare data is vast, and growing at an unprecedented rate. There are tremendous rewards for healthcare organizations that learn to steer through it, but getting to the journey’s end carries many dangers along the way.

A great BI and healthcare analytics program can be that navigator. It will help payers and providers understand their populations at a much deeper level so they can work together to discover an entirely new world of better-quality outcomes at lower costs with greater patient and provider satisfaction.

Now bring me that horizon.

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