Healthcare Industry Issues

Profile

Healthcare Transition

Prudence and estimating threats are implicit when managing risk in 2017. Being diligent and flexible when crunching numbers are important ingredients in today's healthcare environment where a reshuffled landscape in one component of the healthcare industry can have unforeseen consequences downstream for the patient provider. Used thoughtfully patient records are important Business Intelligence tools in an environment emphasizing Access, Quality and Payment

Policy concepts in the public domain as indicated on this page and melded with the patient trend experience are effective when responding quickly. Rapid innovation results where stakeholders require empirical facts and produce insight and discovery congruent with the better care for less money assumptions of the Affordable Care Act.

healthcare analytics Statistical data (descriptive stats, trending charts, clustered data points, etc) that lead to meaningful statistics and actionable results. Experience and Inuitition are the starting points; then comes the data set. Skillfully managed by statisticians and quality professionals, meaningful analytics will focus on "what-if" scenarios and the implications of health reform. Talk of Big data know-how will be frequently mentioned as being at the core of meaningful insights but the skillful use of the enhanced patient discharge record will remain the core set of data elements. Know the future by data mining recent episodic care to manage future care protocol.

Skilled analytics requires a skilled analyst and certified quality clinicians and importantly a Board Certified Quality Assurance physician to see the connections in the data. In tandem the staff with this skill sets is not a luxury expense for the provider but rather can leverage historical data to locate recofnized connections. These specialists are prepared to make constant business service line adjustments for long term organizational vitality. But service line investments are organizational challenges (Knowledge Management), not investment that can capitalized or amortized.

incentive programs Structured programs to monitor and improve health status. structured like any program evaluation abstracts, measurement criterion and benchmarks to measure success/failure rates are tracked over a time continuum. Can certify or debunk anecdotal observations and lead to improved processes. Meaningful results may include financial benefits to reward providers and promote improvements or sanctions that penalize low performing providers inducing future organizational change.

patient engagement The patient acting as an informed consumer is proactive in the maintenance and management of their health status. It's recognized that the biggest cost savings are with complicated patients. Chronic disease patients are usually more likely to utilize high intensity services; the management of these types of cases are high candidates for data mining activities.

Insurers have noted in public testimony that the inclusion of sicker patients into insurer risk pools has increased their medical costs. Can expect increased coordination of care among provider types. In the long run it is expected that consumers will change their healthcare behaviors and adapt healthier lifestyles.

sustainable growth rate A benchmark used by the federal government as it attempts of control federal (Medicare) spending. CMC is postulating that hospitals can provide Medicare patients with better care for fewer dollars spent. These manifestations on the private side are exemplified by more provider organization stand-offs with managed care entities and the resulting contracts not being renewed.

value purchasing The real catalyst for the transformation occurring in the industry, expect to see Payers shift risk, incentivize collaboration (bundled payments) among providers. Will require investment in clinical integration by provider organizations to reduce readmissions, prevent over utilization of expensive diagnostic tests.

Undergirding Insurers initiatives about Value Purchasing are the empirically based findings retrieved from the submitted claims data (patient episode) demonstrating new knowledge and thereby mandating change by providers. In the end insurer costs are better aligned with their costs. The shift from fee -for-service to a value based system will be a gradual but constant transition over many years and many discharge DRG categories. As these risk-bearing models take hold and the ability to reduce cost per test take hold, the ability of providers to identify and micromanage ancillary tests becomes ever more significant for providers.