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Latest Executive Reports

The Medicare Shared Savings Program: Four Tools for Better Profit Margins and High-Quality Care

Medicare patients make up the majority of health systems’ revenue; yet, organizations earn only a one percent profit while caring for this population. Despite historically low profit margins, Medicare can be lucrative for health systems, and through the Medicare Shared Savings Program, healthcare organizations can increase revenue with four tools:

  1. The ability to aggregate and analyze data.
  2. The ability to align financial incentives between payers and providers.
  3. The ability to engage patients in behavior or lifestyle modifications.
  4. The ability to garner support from clinicians and encourage them to lead the shift to VBC.

As the shift from fee-for-service to value-based care continues, health systems can leverage MSSP to deliver the highest level of care while also increasing profit margins.

Survey Points to Major Burnout Concerns Among Clinicians

According to a November 2019 survey, 62 percent of clinicians and other healthcare professionals view burnout as a major problem industrywide. When asked for the best way to address clinician burnout problems, the most popular solution was less-complex workflows, which is the aim of emerging point-of-care analytics solutions.

Responses to additional questions reveal more about clinician burnout experience and views on the technology designed to help:

  1. At your organization, how big of a problem is clinician burnout?
  2. What is the best way to solve clinician burnout problems?
  3. What are the biggest barriers to adopting closed-loop, point-of-care analytics capabilities at your organization
  4. What are the biggest problems arising from a lack of adopting closed-loop, point-of-care analytics capabilities?

Succeeding in Population Health Management: Why the Right Tools Matter

The U.S. healthcare market projects that by 2022 90 million Americans will be in an ACO. The upward trend in population health management (PHM) makes the move towards risk-based contracts increasingly urgent for health systems. The industry has been largely unprepared for the shift, as it hasn’t established a clear definition of population health or solid guidelines on transitioning from volume to value. Organizations can, however, prepare for the demands of PHM by adopting a solution that manages comprehensive population health data, provides advanced analytics from new and complex challenges, and connects them with the deep expertise to thrive in a value-based landscape.

Continuity of Care Documents: Today’s Top Solution for Healthcare Interoperability Demands

While healthcare waits for the expanded data interoperability that FHIR promises, the industry needs an immediate solution for accessing and using disparate data from across the continuum of care. With FHIR potentially several years away, continuity of care documents (CCDs) are the best option for acquiring the ambulatory clinical care data health systems need to close quality gaps today. Because organizations that rely only on claims data to drive quality improvement risk missing out on more that 80 percent of patient information, CCDs are the current must-have answer to interoperability for successful quality improvement.

Healthcare’s Next Revolution: Finding Success in the Medicare Shared Savings Program (Executive Report)

A series of revolutions has driven the development of the U.S. healthcare system, enabling dramatic improvements in all aspects of healthcare quality and outcomes over the past century. Although healthcare organizations have focused on moving towards value-based care for decades, the data shows that the shift is indeed taking place and fee-for-service models are declining.

New changes to the Medicare Shared Savings Program (MSSP) will help drive this change as revisions to MSSP require ACOs to take on more financial risk earlier. This article covers the following topics:

  1. Important moments in history that led to today’s current challenges.
  2. Why financial imperatives drive cultural change in our economic model.
  3. Ways MSSP can help healthcare organizations achieve financial success.
  4. How to utilize data to develop better healthcare delivery systems.

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Healthcare Analytics for Payers: How to Thrive Through Shifting Financial Risk (Executive Report)

To stay in sync with healthcare’s transition to value-based care, payers today must develop the analytics capability to support alternative payment models and drive more value to their members. Payers can follow an analytics roadmap to develop a strategy that extends their data, analytics, and risk management expertise to meet growing demands.

The analytics roadmap helps the payer meet these common challenges of establishing a data-driven culture:

  • Recruiting and retaining high-quality providers in a competitive market.
  • Managing increasing numbers of high-risk/high-cost members with limited resources.
  • Efficiently reacting to federal and state legislative and payment changes.
  • Controlling the rising costs of healthcare services and pharmaceuticals.

Agnostic Analytics Solutions vs. EHRs: Six Reasons EHRs Can’t Deliver True Healthcare Interoperability

As enterprisewide analytics demands grow across healthcare, health systems that rely on EHRs from major vendors are hitting limitations in their analytics capabilities. EHR vendors have responded with custom and point-solution tools, but these tend to generate more complications (e.g., multiple data stores and disjointed solutions) than analytics interoperability.

To get value out of existing EHRs while also evolving towards more mature analytics, health systems must partner with an analytics vendor that provides an enterprise data management and analytics platform as well as deep improvement implementation experience. Vendor tools and expertise will help organizations leverage their EHRs to meet population health management and value-based payment goals, as well as pursue some of today’s top healthcare strategic goals:

  1. Growth.
  2. Innovation.
  3. Digitization.

Extended Real-World Data: The Life Science Industry’s Number One Asset

The life science industry has historically relied on sanitized clinical trials and commoditized data sources (largely claims) to inform its drug development process—an under-substantiated approach that didn’t reflect how a new drug would affect broader patient populations. In an effort to gain more accurate insight into the patient experience and bring drugs to market more efficiently and safely, the industry is now expanding into extended real-world data (RWD).

To access the needed breadth and depth of patient-centric data, life science companies must partner with a healthcare transformation company that has three key qualities:

  1. A broad and deep data asset.
  2. Extensive provider partnerships.
  3. An outcomes-improvement engine to support the next generation of drug development.

Pairing HIE Data with an Analytics Platform: Four Key Improvement Categories

Population health and value-based payment demand data from multiple sources and multiple organizations. Health systems must access information from across the continuum of care to accurately understand their patients’ healthcare needs beyond the acute-care setting (e.g., reports and results from primary care and specialists). While health system EHRs have a wealth of big-picture data about healthcare delivery (e.g., patient satisfaction, cost, and outcomes), HIEs add the clinical data (e.g., records and transactions) to round out the bigger picture of patient care, as well as the data sharing capabilities needed to disseminate the information.

By pairing HIE capability with an advanced analytics platform, a health system can leverage data to improve processes in four important outcomes improvement areas:

  1. Workflow
  2. Machine learning
  3. Professional services
  4. Data governance

The Six Biggest Problems With Homegrown Healthcare Analytics Platforms (Executive Reports)

Most healthcare systems have been building, improving, and maintaining proprietary healthcare analytics platforms since the early 2000s and have invested heavily in the people and resources required to do so. As the demands of today’s healthcare environment continue to increase, it’s becoming more difficult for analytic teams to keep up.

This article deals with the six biggest problems to maintaining a homegrown healthcare analytic platform today:

  1. Inability to keep pace with analytic demands.
  2. Difficult to support and scale for the future.
  3. Difficulty finding and keeping talent.
  4. Use of point solutions to fill gaps.
  5. Analytic teams must also support third-party vendors and affiliated groups.
  6. Difficulty keeping abreast of rapidly changing regulatory requirements.