During the emergency phase of the COVID-19 pandemic, almost half of all U.S. healthcare consumers postponed routine and non-emergent care, leaving organization with significant revenue loss across all care settings. In response to the widespread financial strain on the healthcare industry, Congress has allocated $100 billion in relief funding for hospitals and other healthcare providers. But while providers clearly need the financial relief, using it (including navigating terms and conditions and eligibility) has been less straightforward. Better understanding of these relief programs and compliance requirements will help organizations confidently optimize this assistance.
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The focus on analytics is contributing to the “EHR problem”—doctors prioritizing the EHR over patients. The Healthcare Analytics Adoption Model (HAAM) walks healthcare organizations through nine levels that lay the framework to fully leverage analytic capabilities to improve patient outcomes:
Level 1. Enterprise Data Operating System
Level 2. Standardized Vocabulary & Patient Registries
Level 3. Automated Internal Reporting
Level 4. Automated External Reporting
Level 5. Waste and Care Variability Reduction
Level 6. Population Health Management & Suggestive Analytics
Level 7. Clinical Risk Intervention & Predictive Analytics
Level 8. Personalized Medicine & Prescriptive Analytics
Level 9. Direct-To-Patient Analytics & Artificial Intelligence
Analytics are crucial to becoming a data-driven organization, but providers and administrators can’t forget about the why behind the data—to improve outcomes. Following the HAAM enables organizations to build a sustainable, analytic platform and empower patients to become data-driven when it comes to their own care.
The year 2020 marks a decade since the passage of the Affordable Care Act in 2010 and healthcare’s first transitional steps from volume to value. The 10-year progress report is mixed. On one hand, CMS’s emphasis on quality and cost is driving an upward trend for patients and providers, with substantial improvement in readmissions; on the other hand, organizations still need to simplify and consolidate value-based programs for more widespread positive impact. As the industry enters into another decade of value, it’s time for health systems to consider the impacts of these programs so far and make sure they have the processes and tools in place to succeed in an increasingly value-driven industry.
The Medicare Shared Savings Program: Four Tools for Better Profit Margins and High-Quality Care (Executive Report)
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:
- The ability to aggregate and analyze data.
- The ability to align financial incentives between payers and providers.
- The ability to engage patients in behavior or lifestyle modifications.
- 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.
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:
- At your organization, how big of a problem is clinician burnout?
- What is the best way to solve clinician burnout problems?
- What are the biggest barriers to adopting closed-loop, point-of-care analytics capabilities at your organization
- What are the biggest problems arising from a lack of adopting closed-loop, point-of-care analytics capabilities?
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 (Executive Report)
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:
- Important moments in history that led to today’s current challenges.
- Why financial imperatives drive cultural change in our economic model.
- Ways MSSP can help healthcare organizations achieve financial success.
- How to utilize data to develop better healthcare delivery systems.
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: