Analytics in the era of value-based care
The power of revenue cycle and population health analytics multiplies when you manage them together
Today, revenue cycle and population health analytics need to be managed together, because increasingly, population health and revenue cycle are two sides of the same coin.
The shift toward value-based care isn’t new, but it’s still in its early days. And although fee-for-value is rising, fee-for-service isn’t going away — not anytime soon, and maybe not ever — which makes revenue cycle management even more complex. Providers need population health analytics that help them optimize clinical performance, which in turn helps maximize FFV reimbursement; the FFV reimbursement data has to be integrated into their revenue cycle analytics, which also has to accommodate and help optimize traditional FFS reimbursement. There’s not even any way to predict how quickly FFV will increase as a segment of overall reimbursement. In five years FFV might account for 15 percent of a provider’s reimbursement — or 50 percent. Or 15 percent one year and 50 percent the next.
So it’s no wonder that some in the industry feel like they don’t have enough information to make informed decisions about changing vendors or investing in new technology; the only thing there’s no shortage of is uncertainty. For large organizations, the number of systems involved and the sheer volume of data heightens their concern. They feel like they can’t afford to make the wrong choice, so they decide to take a “wait and see” approach.
Yet the more that organizations delay implementing comprehensive data aggregation and analytics, the more likely it becomes that they’ll suffer a catastrophic revenue disruption — or slowly sink as their reimbursement continues to decline.
Understanding “value” in the context of healthcare
Unlike FFS, FFV models are designed to elevate and reward high-quality care, meaning cost-effective care that achieves improved patient outcomes and supports long-term wellness — and that eliminates inefficiencies and wasteful spending on things like duplicate tests and unnecessary office visits.
That’s why the real need in healthcare analytics isn’t just combining the financial and the clinical. To support accountable and value-based care models, analytics solutions must also encompass and be able to connect all care settings and all provider types. It’s not just a matter of ensuring comprehensive care. To manage value-based reimbursement, many organizations will need data about every encounter their patients have with providers, regardless of whether those providers are in or out of network.
Data aggregation is the foundation of clinical and business performance management
Large healthcare organizations such as accountable care organization, integrated delivery networks, hospitals and health systems need as much relevant data as they can aggregate, in as clean and normalized a form as possible. Comprehensive clinical and patient data is vital for many reasons, but one of the most important is that aggregating data from multiple disparate systems is the best way to identify gaps in care. Comprehensive financial and business performance data is equally vital and can help you manage everything from patient payments to referral leakage to overall claims denial rate or average days in AR.
The better your organization (or vendor) is at aggregating and normalizing your data, the more actionable and impactful your analytics will be. Across all of healthcare, effective data aggregation is the lynchpin of clinical and business performance management — and without it, analytics amounts to little more than guesswork. It’s true that the impact and importance of data aggregation is already widely recognized — but in the coming decade’s blended environment of FFS and FFV, data aggregation and the comprehensive analytics it enables will determine success, not simply contribute to it.
Like healthcare itself, the blend of data needed to support comprehensive analytics is changing; yet, certain realities will remain the same. Claims data will continue to be the most standardized and most thoroughly scrutinized information on patients, the services provided and the associated coverage and reimbursement. The right vendor can deliver additional front-end normalization, as well as auto-populated reporting tailored to different levels of management, making this already detailed and accurate data easier to comprehend and dig into — even when it’s aggregated from dozens of disparate care settings and systems.
Trustworthy information empowers your organization to deliver high-quality, highly coordinated care. It reduces the risk of medical error due to incomplete information and helps prevent redundant tests or procedures. Effective data aggregation benefits your coders and clinicians, since it decreases the likelihood that coders will need to request (and that clinicians will be asked to recall) additional information from after the fact.
How helpful — or how frustrating — your analytics solutions is depends upon whether you can count on it to find the information if and when needed. This will also influence whether top-level management, physicians and staff are confident in the technology’s ability to aggregate and organize the information they need. If they don’t trust it, they won’t use it — and they won’t support analytics-driven decisions and initiatives because they’ll view them as based on flawed or incomplete information.
So how do you select the right technology? Find a vendor that understands and can give you comprehensive visibility into the interconnected drivers of modern clinical and business performance. They should have expertise and experience in optimizing FFS and FFV performance — because although the blend of healthcare is changing, FFS isn’t going away. Sophisticated, well-designed revenue cycle and population health analytics solutions can be your organization’s greatest asset as you grow your ability to deliver consistent, effective value-based care — and the best solutions can help you improve FFS performance at the same time.
Remember that you don’t have to go it alone, and you don’t have to wait to get started. The data you need is available today — some of it at your fingertips, some of it in systems or repositories you aren’t yet connected to. And, cloud-based solutions to aggregate it and make it actionable already exist. So if you’re not currently benefiting from the power of revenue cycle and population health analytics — if your vendor isn’t helping you track and meet quality measures, or can’t provide insight into what’s driving your claims denial rate, or can’t help you find a way to sustainably lower your days in AR — there’s really only one question:
How long until the rising tide of value-driven care and reimbursements puts you underwater, instead of lifting you to new heights?
Doug Fielding is vice president of product strategy and a 14-year veteran of ZirMed, a health information connectivity and management company. As a founding member of ZirMed, Mr. Fielding has held positions as CIO and CPO, where he architected the company’s technology platform and product suite from startup. In his current role, he leads the future product direction for ZirMed and manages the company’s industry standards strategy.