“Healthcare is now on the verge of a new information wave. Call it Data 3.0. At the core of this new age of healthcare data analytics: data this is actionable, explainable, trusted and contextualized,” stated a recent article in HealthcareIT News focused on coverage from the HIMSS Big Data and Healthcare Analytics Forum.

Never before has the need for data that is clear and actionable been more needed in healthcare. Many healthcare leaders are turning to data analytics for business intelligence as they seek to improve efficiencies and generate actionable insights for decision-making. Data from the Harvey Nash and KPMG CIO Survey 2016: Healthcare Sector Findings, which represented 3,400 respondents across 82 countries representing over US$200 billion of IT budget spend, revealed that:

• More than half of CIOs plan to increase their spending on health IT over the next twelve months, a trend impacted by the anticipation of value-based care initiatives, which will demand a heavier reliance on data analytics to manage population health and trim costs from business processes impacted by pay-for-performance models.

• Around two-thirds of respondents stated that increasing operational efficiencies and improving business processes are critical organizational priorities.

• Sixty percent aim to improve the way business intelligence and analytics are reported to executive team members.

• Forty-one percent of CIOs prefer to buy vs. build big data tools, notably cloud-based and SaaS products.

• Forty-three percent of those surveyed plan to sign up with a SaaS cloud vendor within the next three years.

• Integrating cloud-based solutions with existing IT architecture is a challenge for 46 percent of respondents.

• Patient engagement initiatives were noted as a pressure for embracing big data tools.

• Thirty-nine percent of survey respondents said they are in the process of charting a course for a data-driven future for their organizations.

The Role of Claims Data in the Big Data Mix
At INTELLIMED our specialty for 30 years has been in having a complete data solution that gives healthcare leaders usable business intelligence for decision-making. For healthcare leaders planning for “Data 3.0,” the integration of claims data with clinical data from the electronic medical record and other sources will become more and more critical. We know from our customers that the following three areas are of most value to their organization’s leadership when using our claims data for business intelligence and decision-making:

In/Out Migration: Understanding the most vulnerable parts of the business and where that business is going is critical to the lifeblood of any healthcare organization. Leadership needs to be able to quickly assess what is being lost and what is coming in on a quarterly basis. Any data software platform should provide both the percentage of change as well as the actual number value. Ideally, the data is presented both graphically and in a tabular format so that it can be drilled down into as needed to support a decision.
Physician, Patient and Payer Activity: This is the second most significant area of interest for our clients, as physician, patient and payer activity has a big impact on a healthcare facility’s bottom line. Data should reveal things like physician admissions by facility, payers by both service and physician and patient steerage by payer. The data should be refreshed on a 90-day cycle and provide a view of the data that is actionable for benchmarking.

Changes in High Profit Service Lines: We know that changes in a healthcare facility’s service lines can occur quarter to quarter. Data should help tell the story of where patients are coming from for various services – referring partners, long-term care, physician referrals, etc. Claims data has a role to play in determining how well a hospital’s resources are being utilized based on length of stay.

Claims Data and Business Intelligence
Claims, discharge and demographic data has been used by healthcare leaders in data analytic tools for decision-making for some time now. However, their usage has new relevance and meaning in today’s fluid and fast-paced healthcare landscape. Healthcare leaders need data that is easy-to-digest and to take action upon as well as data that shows trends on indicators that impact business metrics and goals that are critical for a healthcare organization’s sustainability.