June 28 2017 | 0 Comments | 338 reads Average Rating: 3.7

4 Realities & 6 Strategies for the New Healthcare World

by Rose Higgins and EXL Healthcare in Health Analytics

A tipping point is on the horizon. Will your healthcare organization be ready for it?

During our recent Webinar entitled “Insight Driven Outcomes: A Focus On Risk, Quality and Provider Networks,” we highlighted that the healthcare industry will soon transition to value-based care. In fact, by the year 2020, value-based care is expected to be the dominant payment model, according to a survey conducted by Lazard. The upshot? Healthcare provider organizations will have to deal with new realities – by implementing new strategies. Here’s a quick rundown of what might come into play as the transformation takes hold.

4 New Realities in a Value Based World

1. Healthcare networks will need to focus on efficient care delivery. Successful networks are likely to include tightly aligned providers. And care will be rationalized among lower cost alternate care sites such as ambulatory facilities, pharmacies and urgent care centers.

2. Healthcare delivery systems will increasingly compete on quality and cost. And, to succeed, advanced analytics will be needed to understand variation and improvement opportunities. Greater efficiency will be achieved by standardizing care across settings and addressing variation while managing a population’s health.

3. Care delivery is best developed and delivered by teams with a focus on care coordination.

4. Value based care is here to stay. With MACRA, MIPS and other value-based payment programs, providers have started their adoption journey and agree that reducing healthcare costs while ensuring quality is the only viable option.

Healthcare organizations need to focus on using data and analytics as a tool that will guide them in meeting their quality-based goals.

6 Strategies for Success

1. Understand the data that your organization collects. Having a data strategy that centers on using impactful data vs. big data (all data). Trend identification is the key.

2. Prepare to rely more heavily on layering data (clinical, financial, behavioral, etc.). Providers should pair the right data together in order to understand where and how care is being delivered – and the nature of any care gaps that exist across care networks. As such, providers will be able to target and improve overall care delivery and quality.

3. Use predictive and prescriptive analytics to transform data into impactful intelligence. Organizations will need to not only understand what happened, but also predict what will happen in the future and what the best strategy is to reach desired outcomes.

4. Drive quality improvements. No matter where providers are on their journey toward value-based care delivery, all will need to focus heavily on delivering higher quality care using the most efficient and effective methods. To ensure optimal performance under value-based contracts, providers need to meet quality measures.

5. Manage population and financial risk. Understand where risk exists across your network and identify high ROI opportunities to reduce that risk.

6. Optimize provider networks. Insights into issues such as referral patterns and leakage can help networks improve efficiency, reduce costs and manage provider quality performance.

The adoption of value-based payments is happening now and accelerating rapidly. It is our observation that payers, providers and consumers are transitioning to these models, but each at varying speeds. Regardless of their location on this path, healthcare organizations need to focus on using data and analytics as a tool that will guide them in meeting their quality-based goals.

These observations provide a high-level overview of the information that we presented in more detail during our recent webinar. Want to learn more? Check out this on demand webinar “Insight Driven Outcomes: A Focus On Risk, Quality and Provider Networks.”

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Rose Higgins
SVP & GM, Data and Analytics

With over 25 years in healthcare, Ms. Higgins brings considerable experience and expertise in working with both payers and providers in addressing the challenges of a changing healthcare landscape.

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EXL Healthcare

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