The public noise about health care reform has painted the parties involved in broad brush strokes that tell consumers which in the fray are the good guys and bad guys. News reports have for so long vilified health insurers that they’re overlooking the forward thinkers who are actively seeking the white hat role and using their heft for real and positive change.
With the near-term incentives to spur adoption of EMRs and subsequent implementation of clinical decision support to make those EMRs “meaningful”, health plans have a perfect opportunity to improve their value. I already see that happening with our health plan customers who have used additional means to improve their populations’ health, such as personal health records, disease management, and other strategic initiatives.
Reform initiatives — and plain old common sense — are trying to pivot provider compensation away from volume of care to focus more on positive outcomes, and as a result, never before have the interests of the insurers and insured been so aligned. Everyone involved would benefit from better treatment outcomes and lowered costs. The tools to accelerate that alignment are available now and payers can facilitate and accelerate the move.
Analyzing available data to better understand the populations they manage will help health plans and other payers be ready to really step up to the white hat role, when the flood of clinical data increases as a result of the systemic implementation of EMRs.
For example, a plan participant who receives a message from his or her provider with up-to-the-minute accurate, personalized information at the point of care is far more likely to modify behavior, experience a “teachable moment” and adhere to treatment than one who receives a generic message two months after the visit to the physician’s office or pharmacy. So why not leverage available data to promote this potentially life-saving scenario?
As we in the analytics world understand well, it’s the not the shortage of data that’s keeping payers and providers from achieving better outcomes and lowering costs. Rather it’s the wealth of data coupled with only primitive means of accessing and utilizing the data. On top of that, it is not a lack of standards that limits accessibility to data, but the abundance of data standards that are not harmonized. The abundance of data will escalate exponentially when EMRs, PHRs, smart medical devices, and other data-generating elements realize critical mass in the marketplace.
What are we seeing more forward-looking payers doing to manage the data and standards that have and will continue to present such a challenge?
First, they’re defining what they do and don’t know about their populations. Digging into the details of a population involves complex layers of analytics, an undertaking that is difficult for most payers because of the vast differences between clinical data and claims data. That said, the pay-off is significant. Even small changes in how payers analyze their claims and other health care data can make vast improvements in adherence. A more complete and layered view of patient populations can move health plans from basic risk stratification to meaningful participant interventions, achieving positive changes in the managed populations.
Second, they develop analytics strategies that can mature from data that’s available now to data that will be available over the next three to five years. It only makes sense to walk before you run, but walking earlier rather than later will gives them a competitive advantage.
Third, they use their power to positively influence the availability of clinical data and demand better tools to leverage the data to ultimately facilitate better care at lower costs. In short, they put on that white hat and embrace the role.
Richard Noffsinger is CEO at Anvita Health, a San Diego-based health care analytics firm.
More on data analytics:
- Next Generation Healthcare Analytics
- On Clinical Groupware, Interoperability, and the HITECH Bill
- Meaningful Health Data Mining: How will we regulate consumer-driven research and advice?