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By Gene Koch

How Behavioral Health is Using Acute Care Hospital Discharge Data for Strategy and Growth

How Behavioral Health is Using Acute Care Hospital Discharge Data for Strategy and Growth

Once upon a time, behavioral healthcare facilities were islands – relatively separate from the rest of the healthcare landscape and not seeking out healthcare data analytics to inform strategy.

That has changed.

With continued consolidation across markets and steady movement toward value-based care, behavioral healthcare organizations are recognizing the need for the right data to make smart decisions about their organization’s strategy and growth. Additionally, competition within behavioral health is increasing and building relationships with acute care hospitals is essential.

Using Hospital Discharge Data for Behavioral Health

We are working with more and more behavioral health organizations – both single state and multi-state facilities – who are needing reliable hospital discharge data to support strategic planning and develop outreach plans for increasing market share.

Data that behavioral health facilities are interested in obtaining from IntelliClient™:

  • Specific, behavioral health diagnosis and procedure codes that show volume of psychiatric admissions for treatment.
  • Identifying the source of admission – physician referral and emergency department are the main sources.
  • Locating the zip codes where psychiatric patients come from.
  • Identifying discharge status – Went home? Long-term care? Behavioral health facility?
  • Pinpointing specific discharging physicians to develop relationships with.

Here’s how behavioral health facilities are using this data for strategy and marketing™:

  • Building relationships with hospitals with high psychiatric patient volume for direct referrals and admissions.
  • Creating and nurturing relationships with attending physicians who are discharging to behavioral health facilities.
  • Understanding market opportunities for establishing or acquiring a behavioral health facility located near an acute care hospital that has high psychiatric admissions.
  • Using the demographic data provided by IntelliClient™ along with the hospital discharge data to investigate and map the dynamics of a given market.
  • The demographic data provides important information related to a given market such as age, gender, ethnicity, income and a 5-year population growth projection for each of these categories.

Behavioral health is looking for ways to grow its business outside of the traditional ways as this market becomes more competitive. Decision-making informed by data will help behavioral health organizations know the acute care hospitals and physicians best positioned to grow relationships with. Data will also help to inform long-term and costly decisions such as new facilities and acquisitions.

Want to learn more? Contact us.

Gene Kochis Chief Operating Officer for Intellimed.

 

By Gene Koch

Integrating Data Silos: 7 Key Benefits for Healthcare

In our article, Healthcare Data Silos: From Medical Tragedy to Opportunity of Accelerating Returns, we discussed the challenges and tremendous opportunities for integrating data silos.

In healthcare, too many silos result in health systems that operate on assumptions – not a good thing for patient safety and when billions of dollars are in play.

We discussed in our article how data silo coordination is key to managing big data and using it for many of the strategic areas healthcare organizations are currently pursuing:

  • Evolving accountable care initiatives and organizations.
  • Creating more coordinated care among providers, health systems and patients.
  • Managing population health initiatives.
  • Implementing and succeeding in new healthcare payments models.
  • Communicating with and marketing to patients as well as providing them with access to their health data for active engagement and healthcare decision-making.

In this article, we’d like to follow up on the topic of data silos and provide some practical thoughts about integration that lead to meaningful big data usage.

  1. Next Generation Technologies: Shifting a healthcare system’s IT infrastructure is no easy task. Yet, implementation of next generation technologies in cloud, remote tele-monitoring and wearables – among others – are designed to distribute data securely and with greater agility.
  2. Clinical Data Warehouse: The first-generation of clinical data warehouses pretty much crashed and burned, but not before spawning the extract/transform/load (ETL) industry. Today’s data warehouses for healthcare are more sophisticated and able to deliver the analytics healthcare executives need. According to leading clinical data warehouse provider Health Catalyst, a data warehouse solutions should deliver analytics that combine clinical, financial, quality, cost and patient experience data.
  3. Governance, Policies & Standards: In addition to the right technologies and tools, a healthcare system must have governance in place as well as policies and standards to ensure usable data sets are available to solve problems, answer questions and uncover opportunities.
  4. Business Strategy: Oftentimes the integration of new data is an afterthought. Making data integration part of business strategy with activities such as mergers and acquisitions, expansions into new markets and IT and other infrastructure and capital investments, provides a better chance that data integration will occur on the frontend rather than the backend of such key activities.
  5. Big Data & Healthcare Providers: Healthcare executives need access to integrated data for business strategy and decision making, but healthcare providers need it as well. The ability to break down data silos to inform clinical care, workflows and the art of practicing medicine will be essential in achieving quality goals within healthcare.
  6. Advancing Medicine: Advancements in medicine require new data in areas such as genomics. Emerging data sources like genomics – which often end up on their own silos – will require integration with other forms of data to recognize their full potential.
  7. Asset Management: Managing a hospital’s assets in no easy task. Breaking down data silos can help healthcare organizations consolidate assets. With reliable data, predictive maintenance and capital equipment replacement forecasting (CERF) can help a system save significant dollars.
Gene Koch is Chief Operating Officer for Intellimed. 

 

 

 

 

By Gene Koch

Is a Marriage of Clinical and Claims Data the Linchpin for Value-Based Healthcare?

Is a Marriage of Clinical and Claims Data the Linchpin for Value-Based Healthcare?

As Walter Cronkite once said, “America’s healthcare system is neither healthy, caring, nor a system.” A bit harsh? Probably. Yet, as our healthcare system continues to march toward value-based care amidst political uncertainties around it, it’s a pretty easy to see there are opportunities for improvement.

Many healthcare systems and providers have payment models that are still dependent on fee-for-service (FFS) revenues, and making the transition has not been easy. According to a survey conducted by analytics vendor Health Catalyst, only 23 percent of healthcare systems said they would meet HHS’ goal to tie 30 percent of traditional FFS Medicare payments to quality through alternative payments models such as Accountable Care Organizations (ACOs).

Many believe this shift, despite what happens with national healthcare policy, is inevitable. With the U.S. spending nearly 18 percent of its gross domestic product (GDP) on healthcare and fee-for-service being a major driver for it, it’s hard to argue that a different model isn’t needed.

As the focus continues to be on reducing volume and increasing value, data will remain at the heart of this process. While there are many forms of data that play a role in value-based care, we believe that these three are the most critical forms of data and the linchpin for success:

  • Clinical Data
  • Claims Data
  • Demographic Data

The Two Major Players: Providers & Payers

According to healthcare leader Emad Rizk, M.D., the shift from fee-for-service to value-based care can’t be administered by providers alone. A huge player and administrator of it must be payers, he said in a recent Healthcare Informatics article, adding that payers do not yet have the systems in place to be able to pay for a bundled payment.

With providers as the keepers of the clinical data and payers as the keepers of the claims data, it only seems logical that these two entities will need to work closely together in value-based care.

Providers and Risk-Based Contracts

For providers working in environments with value-based care models where payment is dependent on outcomes and quality, claims data will offer a much more complete picture, when combined with clinical data, of a patient’s health. While claims data has a lag time, taking weeks or more to process, it can effectively be used for predictive modeling for future care and cost management. Combined with clinical data, success or failure can be better demonstrated.

System Redundancies

Redundancies within healthcare are notorious. Claims data can reveal redundant, misused and overused tests and services. Adding clinical data to the mix can help to inform care plans and create greater efficiencies within a healthcare system, with the goal to avoid waste and redundancies.

Interoperability

In the early days of health IT, the goal was to get healthcare data from paper to an electronic format. We’ve sure come a long way. Now, interoperability has replaced electronification of healthcare data as the next big step. Unfortunately, the healthcare system offers little incentive to commercial electronic medical record (EMR) vendors to be interoperable with one another. At minimum within a system, marrying a system’s clinical data with claims data can provide a more holistic picture for care, strategy and risk management.

Our Clients

At Intellimed, a healthcare data analytics company, we don’t pretend to have all the answers to success in value-based healthcare. However, in working with our clients, we see that the ones leading the way and doing it with the least amount of pain are marrying clinical, claims and demographic data to inform their value-based strategies.

Understanding Healthcare Market Share Changes in a Value-Based, Patient-Centered Landscape

By Gene Koch

Understanding Healthcare Market Share Changes in a Value-Based, Patient-Centered Landscape

Understanding Healthcare Market Share Changes in a Value-Based, Patient-Centered Landscape

The old model of hospital/healthcare market share that focused on high-margin, high-volume procedures (notably inpatient) used to be the best way to evaluate a healthcare facility’s competitive position. However, this model is quickly becoming less relevant as a new healthcare model – largely fueled by the Affordable Care Act – is taking hold. The new model focuses on transforming the healthcare system from an inpatient sick care model to an outpatient model centered around community-based healthcare that values:

  • Quality of care over volume of care.
  • Operational efficiencies to deliver the highest quality care at the best cost.
  • Placing the healthcare consumer/patient at the center of care and delivery.

Before we dive into how these changes affect market share and how data can be leveraged for strategic planning to increase and improve market share, let’s look at some compelling data from the American Hospital Association’s 2015 environmental scan that will continue to impact market share changes:

  • 78 million baby boomers are expected to live longer, and, for many, with chronic conditions that will continue to put pressure on the healthcare system.
  • The percentage of workers with high-deductible plans increased from four percent in 2006 to 20 percent in 2013 – and is projected to continue rising.
  • A decline in the number of uninsured individuals as a result of health care reform will reduce bad debt for healthcare institutions, but out-of-pocket increases for the consumer will likely keep volume weak.
  • Payers are adapting to affordability imperatives by actively excluding some hospitals whose costs are higher and collaborating with those institutions willing and able to accept lower reimbursement rates.
  • The economic feasibility of independent medical practices will continue to evaporate, with an estimated 75 percent of physicians likely to become hospitalists by the end of this decade.
  • Seventy percent of organizations that reported a transition toward value-based contracts by payers also saw an increase in healthcare consumerism, with patients seeking greater price transparency, challenging orders for services and negotiating payments.

Furthermore, we know that a decline in inpatient care – driven by technological advances in medicine, economic considerations and the ACA – is pushing both horizontal consolidation (hospitals merging with other hospitals) and vertical consolidation (hospitals consolidating with other healthcare provider entities) across all U.S. health regions, according to a Journal of the American Medical Association article.

Healthcare Data and Market Share Changes

The most important part of a healthcare organization’s operational strategy is its ability to keep up with the ever-changing healthcare landscape by being aware of all elements that impact its market. This is where data – both internal data and external data such as healthcare claims data – can be of great value. Let’s take a look at three key areas where hospitals typically seek to gain market share and how the right data will support better strategic decisions with the results being increased market share.

Healthcare Data & Patients
Patient loyalty is critical in the new healthcare model. The ability to measure your healthcare consumers’ experiences across their entire healthcare network is more important than measuring solely on a single point of care. Data can show you where consumers are choosing to go for their care by zip code as well, so that changes and trends can be pinpointed for all data points in a data set.

Healthcare Data & Physicians
The new model of healthcare is focused on creating a healthcare system that is integrated and works with its physician partners to meet the needs of patients across the continuum of care. Data can help you monitor, measure and assess the strength of your facility’s physician network, including both primary care doctors (key components of the new accountable healthcare models) and specialists.

Healthcare Data & Payers
External data such as claims data can help you to determine the payer mix among your competitors. It is also possible to determine which healthcare system or hospital is getting the best reimbursement for procedures among payers in the market. In order to obtain this level of detail, you’ll want to ensure that the is robust enough and covers at least 65-85 percent of the market.

Gene Koch serves as INTELLIMED’s Chief Operating Officer and is a member of the INTELLIMED leadership team. In his free time, he loves to play golf, travel for pleasure and mentor students in several MBA business classes.

 

 

How Behavioral Health is Using Acute Care Hospital Discharge Data for Strategy and Growth
Integrating Data Silos: 7 Key Benefits for Healthcare
Is a Marriage of Clinical and Claims Data the Linchpin for Value-Based Healthcare?
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Healthcare Data Silos: From Medical Tragedy to Opportunity of Accelerating Returns
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Actionable, Trusted and Contextual Data Key to Healthcare Data Analytics
Understanding Healthcare Market Share Changes in a Value-Based, Patient-Centered Landscape
Understanding Healthcare Market Share Changes in a Value-Based, Patient-Centered Landscape