Red Carpet Customer Service: User Experience (UX) & Customer Experience (CX) in Healthcare Information Technology

Aug, 2018

Red Carpet Customer Service: User Experience (UX) & Customer Experience (CX) in Healthcare Information Technology

We all know how important the user experience (UX) is in designing and evolving a healthcare information technology solution. We know that it’s important to design health IT solutions that are easy and intuitive to navigate and provide users with the information they seek.

Of course, as a healthcare data analytics technology company, we certainly appreciate and are mindful of the user experience when designing new products and evolving our existing solutions. But what about the human side of the user experience – the customer experience (CX)? In today’s uber-techie world, many companies are foregoing high-touch CX experiences in favor of email support, live chat and other technology-enabled support. And, for some products, that works just fine.

But for an industry like ours where we are serving healthcare analysts up to the C-suite within healthcare systems who rely on our data for business decisions with multi-million-dollar impact, support can’t end at UX. UX must be tied to meaningful customer experience (CX) to create a red carpet customer service approach.

Defining User Experience (UX)

UX is the customer’s experience with the technology, in our case our claims data analytics solution. UX is centered solely around the solution’s usability, structure, navigation and ease-of-use – all highly important. The ultimate goal of UX boils down to designing a product that efficiently and enjoyably meets the user’s needs.

Defining Customer Experience (CX)

Whereas UX is confined to the user’s experience within the technology, CX is broader in scope to include the customer’s experience with all aspects of the company, including:

Customer service
The sales process
Pricing
Branding and marketing
Company operations
Product delivery and updates

UX + CX = The Ultimate User Experience

Before the fancy UX and CX acronyms for user and customer experience came around, at Intellimed – for 35+ years – we have been rooted in two things:

Providing the best-managed and most insightful claims data in the industry
Offering a high touch solution-focused customer service experience

So, CX has long been part of our DNA. With our newest product IntelliMarket™, we are adding additional emphasis on UX with the goal of providing a customer experience that merges the best of both user and customer experience.

Here are some ways we have and will continue to support the full user experience:

Multiple points of contact:Our clients have access to not just their designated account representative, but to multiple points of contact within our company, including developers; data specialists; sales and operations; as well as our management team.Two of our company’s core values are to be relationship-focusedand responsive. To that end, we work hard to make it as easy as possible for our customers to reach who they need to reach for what they need when they need to – they do not need to go through layers of support wasting their time and energy.
Client-focused mindset:We are always asking the question “How can we make our clients’ jobs easier?” Being a data analyst within a hospital system comes with stress and pressure. From managers up to the C-suite, people are relying on the data teams to deliver insights from our solutions to inform strategic business decisions. We strive to stay in touch our analysts and ask questions to understand their pain points. We know first-hand that data teams have slept overnight at their jobs and worked long weekends to meet data deadlines for critical reporting. When we receive an SOS from an analyst, we take it seriously and collaborate until the problem is resolved or the necessary information is in-hand – hopefully avoiding as many long nights and weekends at the office, as possible.

Collaborative Product Development:

IntelliMarket™ was developed in collaboration with our customers, who helped create the use cases, test the product and provide critical feedback. As we iterate IntelliMarket™ as well as our original IntelliClient™ solutions, we will continue to seek our customer’s critical input along the way.

Nathan Schnell is Vice President of Service Delivery at Intellimed.

Apr, 2018

By Bill Goodwin

Intellimed Volunteer Day with Feed My Starving Children

Our team had a great time taking a day off this week to volunteer with Feed My Starving Children, a national organization dedicated to providing nutritious meals to children worldwide. While we all work hard at Intellimed and it’s not always easy to find time to take a day to volunteer like this, we always find it’s well worth it for the contributions made and time together as a team.

Here’s the stats from our volunteer day:

214 boxes packed
46,224 meals
126 kids feed for a year

Apr, 2018

By Sarah DeSantis-Sullivan

4 Themes from HIMSS 2018: Their Role and Impact on Healthcare

Our team is just got back from HIMSS 2018; The health IT industry’s big annual event, 40,000 of our colleagues also attended! In addition to the attendees, hundreds of exhibitors, presenters, and events took place at the conference, highlighting a wealth of opportunity in health IT. This year, we noticed the following four topics woven throughout many of the presentations, exhibits and discussions.

Interoperability– Healthcare continues to have opportunities and challenges related to interoperability. TheHIMSS Interoperability Showcase, a 30,000-square-foot exhibition that demonstrated the opportunity to connect health and care, was a great place to get the “lay of the land” on what’s new in the space. The realization of true interoperability continues to face obstacles, with many of the Showcase solutions addressing the following key challenges:

o EHR Customizationsthat provide the flexibility to meet the unique needs of a healthcare system, frequently at the expense of increased complexity of integrations.

o The staggeringvolume of data, measured in Petabytes, that healthcare organizations are collecting from disparate sources with the intent to integrate. Tools including cloud computing, data warehouses, and big data will continue to be valuable in overcoming this interoperability challenge and avoiding data silos.

o Patent matching is critically important to quality and a significant safety concern. In the absence of a national patient identifier,errors in combining multi-sourced patient data are common. As patients seek care in a variety of facilities and data becomes increasingly shared across EHRs and other data systems, a better system must be created to ensure patient matching is improved.

Blockchain– According to Healthcare Rallies for Blockchain, a study from IBM, 16% of surveyed healthcare executives had solid plans to implement a commercial blockchain solution this year, while 56% expected to by 2020. The potential to establish the lifetime history of data related to a person, place or thing has great relevance in the healthcare space – think medical data management for patient history. Ultimately, blockchain offers the possibility to make data more secure, complete and readily accessible, all driving improved treatment efficacy and enhanced privacy.

Internet of Thing (IoT)– IoT continues to have great promise for healthcare, with possibilities spanning remote monitoring to device integration. It can help care teams more effectively monitor patients, efficiently deliver care, and better engage patients in their own care. However, IoT creates a data challenge for healthcare systems to manage, govern and integrate the voluminous and disparate data of the connected devices.

Cyber Security– Cybersecurity continues to rank a major concern for healthcare executives. HealthIT Security recently reported that with two years of a steadily increasing cyber threat landscape with record number of patient records compromised, health organizations extorted financially, and hospital operations disrupted, things will continue to be challenging in this space.Intellimed recently wrote a blog on healthcare cybersecuritythat includes critical prevention steps that we invite you to check out.

As the dust settles from HIMSS18, we’re all back to work energized to make healthcare work its best for all stakeholders – the patients, healthcare systems, and payers. We all know that health IT is a critical part of the healthcare puzzle. We hope you had a great HIMSS18, if you attended, and found our short recap here helpful.

Sarah DeSantis-Sullivan, Vice President of Product Development

healthIT, HIMSS, HIMSS18, HIT

Jan, 2018

healthcare, healthcare IT, HIT, wearables, digital health

By Nathan Schnell

4 Healthcare IT Trends to Watch in 2018

As we head full steam into another year sure to be full of change for healthcare, we thought we’d offer a roundup of healthcare IT trends predicted for 2018 by health IT writers, editors and analysts. Ready? Here we go…

Artificial Intelligence

While artificial intelligence (AI) is currently used to automate simple tasks, 2018 is predicted to be the year where it will make its way into clinical support and decision making. Currently many healthcare organizations already use AI for clinical decision support, population health, disease management, readmission and claims processing. But experts believe 2018 will be the year AI will make inroads into cancer diagnostics, pathology and image recognition, according to a recent SearchHealthIT article.

Health Data Management predicts that by 2021, 20 percent of healthcare and 40 percent of life science organizations will have recognized a 15 to 20 percent in productivity gains by adopting AI technology, noting that adoption resides mostly in large academic medical centers at present. Industry analyst Forrester predicts that AI as well as the Internet of Things (IoT) will be part of the disruption of siloed healthcare ecosystems in 2018.

Digital Health

According to seed fund Rock Health, a record-breaking $3.5 billion was invested in 188 digital health companies in the first half of 2017, with the number of wearables is set to hit 34 million by 2022.

Digital health has been gaining momentum for many years with the wearable trend. According to a Forbes article, the most frequent users of wearables are the least likely to be hospitalized.

Additionally, the Food and Drug Administration (FDA) recently issued new guidelines that loosen regulations for some mobile health technologies, recognizing that clinical evidence supports better health outcomes with mobile device usage. This change will likely encourage healthcare organizations to better embrace the integration of consumer digital health device data.

Telehealth and telemedicine are predicted to grow as more states update laws to expand access to these services. With one in five U.S. adults suffering from mental illness, a noteworthy predicted area of expansion is telemental and telebehavioral health services, according an article by SearchHealthIT.

Blockchain

The promise of blockchain, the technology invented to power Bitcoin, has been around since 2008. However, this year may be the year its value starts to be recognized and leveraged within healthcare. HealthDataManagement predicts that by 2020, 20 percent of healthcare organizations will be using blockchain for operations management and patient identity.

However, as noted by SearchHealthIT, blockchain has “yet to prove itself in the demanding crucible of health IT systems and clinical healthcare settings,” but notes that “IBM, Intel, Google, Microsoft and others have units dedicated to development of blockchain products, including for healthcare.” Federal health IT officials are promoting it heavily as well.

Electronic Health Record Analytics

To be successful, EHRs will need to move into providing analytics that support population health initiatives and value-based healthcare – and many predict 2018 will be the year where headway will be made by EHRs in analytics. The big players like Cerner and Epic already have population health products and other smaller vendors like cloud-based AthenaHealth do as well. More are predicted to join and more healthcare organizations will likely take advantage of these products.

Nathan Schnell is Vice President of Service Delivery at Intellimed.

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Dec, 2017

By Jennifer Zweifel

Congress’ Tax Bills: The Impact on Healthcare and the Affordable Care Act

The House and Senate have now passed versions of the biggest rewrite of tax law in decades. If you are filing your taxes you should get a PAN card to help save all your documents for future references, here are essential PAN documents that you will be need.

Since the bills are not identical, the final legislation must be negotiated in a conference committee. While not all provisions will survive, it is predicted that the final bill will most closely resemble the Senate version, which includes repealing the Affordable Care Act’s individual mandate, according to an article by the Association of Health Care Journalists (AHCJ).

Our team at Intellimed wanted to know the impact on healthcare of Congress’ bills. Here’s what we learned…

Impact on the Affordable Care Act (ACA)

Both bills as they stand now would significantly impact ACA/Obamacare. The biggest changes include:

Abolishment of Mandatory Insurance Coverage: The Senate tax bill would eliminate the government’s enforcement of the ACA requirement that most Americans carry insurance coverage. According to a recent Chicago Tribune article on the bill’s impact, abolishment of the coverage mandate would result in government savings from fewer consumers applying for taxpayer-subsidized coverage, giving GOP tax writers nearly $320 billion over 10 years to help pay for tax cuts. With healthier people opting out of insurance and foregoing a penalty, it is speculated that premiums would continue to rise for those maintaining coverage. The Washington Post concurs in its coverage, stating “The result could cause an extra 13 million people to become uninsured and drive up insurance premiums in marketplaces created under the law, according to anestimate by Congress’s nonpartisan budget analysts.

The House bill would not end penalties for Americans who fail to carry insurance. However, House Republicans have been sympathetic to the idea, which was part of legislation the House adopted this year to dismantle much of the ACA.

Impact on Medicare: The impact on Medicare is somewhat unclear. However, the impact of both chambers’ bills is predicted to increase federal deficits by about $1 trillion over 10 years, even after accounting for stronger economic growth expected from tax cuts. More red ink means higher borrowing costs for the government, and that would reduce the options for policymakers when Medicare’s long-postponed financial reckoning comes due, although GOP leaders House Speaker Paul Ryan, R-Wisc., and Senate Majority Leader Mitch McConnell, R-Ky. said in a joint statement that speculation about the tax bill’s cuts to Medicare are unfounded, according to the Chicago Tribune.

The Washington Post notes, “Cuts, if they happen, would decrease federal spending on Medicare by 4 percent — amounting to about $25 billion next year, the Congressional Budget Office forecast. Because paygo rules do not allow Medicare benefits to be touched, the funding loss would be spread among payments to doctors, hospitals and others that provide care to the program’s 56 million older and disabled Americans.
Impacts to Federal Programs for Low-Income Americans & CDC: The bills would leave untouched some health-care programs that provide help to low-income Americans, including Medicaid and the Children’s Health Insurance Program (CHIP). Nearly $1 billion a year would be eliminated for a Prevention and Public Health Fund, created under the ACA that now represents 12 percent of the Centers for Disease Control and Prevention’s (CDC) budget, according to The Washington Post.
Tax Deduction for High Medical Expenses: The House bill repeals the tax deduction for people with high medical expenses not covered by insurance. The Senate bill would make the deduction more generous than what’s currently allowed. People could deduct amounts that exceed 7.5 percent of their income. The differences would have to be resolved in conference.
Tax Credit to Drug Companies: In an effort to raise money to pay for lower tax rates, the House bill eliminates a current tax credit available to drug companies that develop medications for people with rare diseases; the Senate bill scales back the tax credit.

Health Associations’ Take on the Republican Tax Bill
In a joint statement this month, the American Psychiatric Association, American College of Physicians, American Congress of Obstetricians and Gynecologists, and American Academy of Pediatrics, among others, voiced opposition to the Republican tax proposal. The main concern of these groups was around repeal of the individual insurance mandate, which would leave millions more people uninsured by 2027, according to the Congressional Budget Office (CBO), with speculation that individual and small-group marketplaces would be destabilized and rates of medical bankruptcy would skyrocket.

And the Story Continues…

The tax bill story is certainly not over and we’ll all get to watch it unfold over the coming weeks and months as we head into the New Year. We hope this quick overview of the House and Senate bills’ impact on healthcare has been informative. Please add your comments and let us know if we’ve missed any key points.

Jennifer Zweifel serves as Chief Financial Officer of Intellimed, a leader in healthcare data analytics software and analysis based in Phoenix, AZ.

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Nov, 2017

By Kim Carlson

8 Ways Claims Data Supports Population Health

Effective population health initiatives implemented by hospitals, large physician groups, payers, self-funded employers, among others require data analytics to be successful. The right data can inform population health strategy, goals and outcomes. While healthcare claims data is not the only data required for population health, it is a big factor in driving improvements in population health programs.

Here are eight ways we believe healthcare claims data can inform population health initiatives:

Managing Overall Costs: Claims data can shed light on the disparate prices doctors and hospitals charge for the same procedures. The data can show total spending within an institution by procedure as well. Claims data can reveal which service lines are performing well and which are struggling with cost-containment.
Physician Performance: Claims data can help to determine the performance of individual physicians through analysis of the services provided by diagnostic code. Data can reveal if physicians are following nationally recognized medical protocols. An example is diabetes care: According to the Pew Charitable Trusts, claims data can reveal whether a doctor followed nationally recommended protocols for treating patients diagnosed with diabetes. How many received quarterly exams? Did they receive an eye exam? How many were admitted to a hospital?
Empowered Consumers: Some states through all-payer claims databases (APCDs) are making claims data available to healthcare consumers, with the idea that when consumers can compare prices across physicians and hospitals, they will make better and more informed decisions regarding both quality and cost.
Improving Quality and Outcomes: When combined with clinical data, healthcare claims data can provide a very broad view at both the patient-level and population-level of interactions across the continuum of care within a healthcare system.
Reduce Hospital Readmissions: Claims data can help to reduce costly hospital readmissions by uncovering areas by service line and/or at the physician-level where readmissions are occurring most frequently.
Patient Engagement: Patient engagement is a key to successful population health. Claims data can help reveal when to reach out to patients as well as whether patients are filling prescriptions or following-up with recommended lab tests. In the past, technology lagged when using claims data to reveal patient patterns. However, newer analytics allow for as little as 15 days to reveal patterns such a prescription refills or follow-up tests, providing healthcare clinical teams a reasonable window to follow-up with patient outreach.
Strengthen Coordination of Care: Claims data, notably when coupled with clinical data, can inform the actions of care teams that can include physicians, care managers, health coaches, caregivers and even the patients. Creating data transparency through patient portals and other tools that aggregate data into usable information allows for care plans to be adjusted to the patient’s needs.
Amp Up Reporting: The best reporting reveals where there are opportunities to improve and where health systems have effectively made changes. Claims data when coupled with clinical and other data can reveal these insights. Such insights can improve population health initiatives that help to contains costs and improve healthcare quality resulting in healthier populations and healthcare systems.

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Oct, 2017

By Trisha Young

SHSMD 2017 Highlights and Key Takeaways

Intellimed recently attend the American Hospital Association’s Society for Healthcare Strategy & Market Development (SHSMD) annual conference – SHSMD Connections – in Orlando on September 24-27, 2017.

The event provides a fantastic opportunity for healthcare marketing, public relations and communications and strategic planning professionals to come together to exchange ideas, learn about new product innovations and network.

Many of Intellimed’s clients attend this event and are the individuals within their organizations who use our healthcare data analytics solutions daily, notably our IntelliClient.

In this day-and-age of fast and furious email communication, social media and information abundance via the Internet, attending an event like SHSMD is a breath of fresh air. It allows us to:

Share our product improvements with our current and prospective clients.
Hear about customer and prospect challenges and how we may be able to help address them with our tools.
Gain insights into how we can make improvements to our solutions to meet changing market needs.
Reinforce Intellimed’s commitment to a high-quality, high-touch approach to healthcare data analytics solutions.
Learn about other products and services in the healthcare data analytics market.

Here are some highlights and key takeaways from the SHSMD event:

Intellimed enjoyed participating with 140 other exhibitors, providing conference attendees with industry-leading services and solutions.
Lots of fun pictures over on SHSMD’s conference Facebook page.
Cocktails before the opening keynote along with the crowd being serenaded by local a cappella group reVoiced – a nice change from the standard conference kick-off activities.
Opening keynote speaker, Ceci Connolly, President and CEO at theAlliance of Community Health Plans, who discussed healthcare’s biggest challenges – from high-deductible plans to rising drug prices to payer consolidation. Ceci offered many new and insightful perspectives on these challenging issues.
Some reoccurring themes throughout the event:
- Accountability matters among providers and patients with focus on design thinking, population health, appointment follow-up communications, digital tools and more personalization
- Consumers continue to expect experiences in healthcare on par with what they’ve come to expect from other industries and healthcare must rise to the occasion.
- Marketers must measure ROI – a common healthcare pain point – with emphasis on marketing as a profit versus cost center.
- Marketing must continue to move toward digital with emphasis on using technology to measure outcomes and track data, which the C-suite demands.
- Mobile matters and patient experiences must be tailored to it from search to the experience a patient has on a hospital’s website.

Kudos to SHSMD for another great event!

Intellimed looks forward to attending next year, which given the fast-paced changes happening in healthcare, will again prove to be enjoyable and insightful.

Oct, 2017

By Nathan Schnell

Predictive Analytics in Healthcare: Trends, Challenges and Why We Need It

Data from the National Academy of Medicine shows that the U.S. healthcare system spends $750 billion annually – almost a third of its resources – on unnecessary services and inefficient care.

Predictive analytics tools, long used in other industries like retail to forecast the likelihood of an event, are one of the critical tools for reducing healthcare waste and improving patient care and outcomes.

A 2017 survey by the Society of Actuaries looked at the trends in use and future use of predictive analytics in healthcare:

57% of executives (providers and payers) forecast predictive analytics will save their organization 15% or more over the next 5 years, with 26% forecasting saving 25% or more over the next five years.
47% of providers currently use predictive analytics.
93% say predictive analytics is important to the future of their business.
Providers cite patient satisfaction as the most valuable outcome for using predictive analytics.
Payers cite controlling costs as the most valuable outcome for use of predictive analytics.

Despite what seems like strong support from this data, there are major barriers to the adoption of predictive analytics in healthcare.

Challenges to Using Predictive Analytics in Healthcare

The top 5 challenges for implementing predictive analytics from the Society of Actuaries study are:

Lack of budget – 16%
Regulatory issues (e.g. HIPAA) – 13%
Incomplete data – 12%
Lack of skilled employees – 11%
Lack of sufficient technology – 10%

In addition, a recent Harvard Business Review article notes that the success of predictive analytics in healthcare depends less on the tool used and more on the buy-in at all levels of an organization from the start. The authors cite the following major challenges:

Engaging the right people from the outset – Whether the tool is developed in-house or purchased off-the-shelf, the right people should be involved in the process, with a multi-disciplinary team comprised of clinical, analytics, data science, information technology and behavior change skill sets.
Change agents and clinical champions – Change agents are essential to successfully implementing predictive analytics, particularly for sustaining its usage. These individuals often work alongside clinicians to map workflows and identify changes and new processes. In addition, clinical champions are a must to promote the tool among their clinical peers.
C-suite commitment – Frontline buy-in is essential, but without the full commitment of the C-suite, predictive analytics won’t take off or be fully utilized. Identifying measures that resonate with management is important, such as financial penalties associated with hospitals readmissions.

Why Implement Predictive Analytics in Healthcare?

As noted in the HBR article, “Implementing predictive analytics is a means to an end – where the end should represent an improvement in health or health care outcomes, including lower costs.”

Additional major reasons as noted in Hospitals & Health Networks include:

Success in the shift from fee-for-service to value-based care, which may be impossible without the use of predictive analytics, along with data warehousing and integration.
Being able to understand a healthcare system’s current state is a must for being able to forecast a desired future state and associated plan to get there.
The ability to get in front of healthcare consumer trends.
Supporting population health initiatives.
Improving patient care: reducing hospital readmissions, reducing hospital stays, anticipate staff needs and more.

Ultimately, predictive analytics in healthcare is about translating data and science into practical applications to solve complex clinical and business problems that improve care and control costs. The end game? Strategic, cost-effective high-value care.

Sep, 2017

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.

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.
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.
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.
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.
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.
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.
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.

Aug, 2017

By Gene Koch

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.

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