Healthcare is in an in between state. Changes in regulation, payment methods, medical research, newtechnology demographics has created uncertainty and turbulence.
One of the most significant challenges to employing analytics is the underlying data. Traditional Data Warehouses, MDM and Data Governance approaches help, but are not sufficient. Applications and data crisscross over multiple functions creating a confusing network of connections, redundancies, gaps and dependencies.
More and more hospitals, doctors, insurance companies, pharmaceutical manufacturers, governments and others in healthcare are using advanced healthcare analytics to achieve:
We recommend thinking in terms of Data Harmonization. It is a broader,function focused approach to take data from many systems and align it with the functions of an organization.
Data Harmonization utilizes Data Warehouses, MDM and Data Governance, but has the supporting function at the center – not which data element has primacy. Harmonized data enables Advanced Analytics and brings many benefits to Healthcare. Below are some examples of how Advanced Analytics can help Physicians, Hospital Systems, Health Insurance and Government achieve their common goals:
ADVANCED ANALYTICS IN ACTION
Emergency Room Visits
The limited availability and high cost of maintaining Emergency Room (ER) facilities are under incredible scrutiny by payers, government, providers, and employers. According to the CDC, in 2014 Americans made 136 million ER visits. According to a study published in the American Journal of Managed Care – more than 30% of ER visits were avoidable.
Reliable Software’s analytics team can help you collect the data from disparate data sources and implement the appropriate predictive model to reduce the emergency visits.Analyticscanlower costs of care, shorten wait times and improve outcomes.
There are several environmental factors (social, demographic, economic, behavioral, ethnic, etc.) that contribute to patient admission and/or readmission rates to a hospital. Delivery care (both inside and outside the hospital) have a significant influence on the continuity of care available to a patient, and the multitude of clinical decisions physicians make on an ongoing basis impact the care a patient receives. This interplay of factors influences both the clinical as well as social diagnosis (the environment a patient comes from before admission and goes to after discharge) has to be better understood if continuity of care is to be long-term focused and optimized.
Reliable Software’s readmission analytics team uses an integrated toolbox of policies, processes, and information to improve decisions related to patient outcomes.
Coordination of Benefits Identification
According to the Census, over 20% of the population has more than one health insurance plan in a year. Processing Coordination of Benefit (COB) claims is often incorrect due to incomplete information. Finding these individuals means reduced administrative work for Providers and potential cost recoveries for Health Plans.
Reliable Software’s sophisticated data mining techniques and scoring algorithms can identify people that have other health care coverages.
Early Chronic Health Detection
Chronic health conditions, such as heart disease, stroke, type 2 diabetes, cancer, andchronic lung diseases, —account for 86% of total health carecosts. Many of these conditions are preventable. Wellness programs are in place to encourage people to stay healthy.
Reliable Software analytics can enhance Wellness programs by identifying people that are at higher risk of acquiring a chronic health condition before it manifests itself. Intervention before the onset of conditions like diabetes can improve the life of people and contain costs.
Supply Waste Reduction
After staff, the second largest expense for Hospitals are supplies (about 17% of expenditures). Reducing supply chain costs and losses increases the profitability of the Hospital. Reliable Software can develop the predictive models to improve ordering, reduce urgent orders, and cut losses due to expiration.
In addition, Analytics can indicate when a claim may have insufficient supply charges for a procedure and can be flagged for verification to ensure correct reimbursement.
Moneyball for Hospitals
72% of healthcare executives are concerned with staff shortages. A hospital that is short one physician loses about $1M in revenue per year.
Reliable Software’s analytics can use the history of encounters and current schedules, to better allocate resources, thus reducing gaps. Also by analyzing past encounters and associated work force data, ideal combinations of teams can be identified that perform procedures more efficiently and with quality outcomes.
Pre Authorization Automation
Delays in pre-authorizations by Health Plans can cause Member and Provider dissatisfaction. Pre-authorization can be accelerated by partially automating the analysis and decision making process of a case.
Reliable Software will develop the models and rules engines to reduce the overall workload per Case reviewer. In doing so, the same number of people can process more pre-authorizations and improve satisfaction.
Volume to Value
As commercial and government payers continue to reduce reimbursement rates, and shift to value rather than fee for service, Hospitals need to treat a larger volume of patients to break even.
Reliable Software recommends Hospitals should draw upon consumer engagement and retention analytic strategies that have been used in retail and other industries to attract and retain patients. Our experience will help you segment and attract patients and keep the ones you already have.
Contact Our Experts
The breadth and depth of Advanced Analytics continues to grow, and the above is just a sample of some of the areas where we can help.
22260 Haggerty Rd, Suite#285,
Northville, MI – 48167