July 06 2017 | 0 Comments | 233 reads Average Rating: 3.7

Payers and Providers Start Singing the ‘Better Together’ Tune

by David Hom and Lesli Adams, MPA (Guest Author) in Health Analytics

As value-based payment models becoming more common, payers and providers are realizing that there is value in working together to reach mutual goals. A complete view of healthcare quality and costs is critical when working under models that base payments on clinical and financial outcomes, and not merely on the volume of services provided. Payers and providers are discovering the value of sharing vast amounts of data -- such as that in claims, clinical, social, economic, and more types -- just to name a few.

Sharing is just a start, though. What is perhaps even more important is that these organizations need the ability to make sense of all this information. They need to understand that acquiring meaningful data is far more important than assimilating volumes of data. Once organizations have the right data, they can rely on predictive and prescriptive analytics to gain meaningful insight into the data to spot trends, performance outcomes, etc.

In fact, according to a recent Society of Actuaries survey of 223 payer and provider executives, 90 percent (90%) of respondents indicated that healthcare organizations will not be able to navigate the financial and clinical challenges of the future without investing in predictive analytics tools.

The majority of payers and providers participating in the February 2017 poll agreed that predictive insights will be critical for the future of their businesses. More than a quarter of the respondents stated that they expect big data analytics tools to save them 25 percent (25%) or more on costs over the next five years. What’s more, 47 percent (47%) of providers and 63 percent (63%) of payers said they currently use predictive analytics tools. Over the next five years, just fewer than 90 percent (90%) of both payer and provider organizations said they will have adopted some form of forward-looking, big data analytics capabilities.1

SCIO is a Gold Partner of the Oracle Corporation. Working together, they enable customers to win risk contracts and improve care quality ultimately by collecting, organizing, and acting upon valuable healthcare data.

Oracle Healthcare Foundation enables organizations to aggregate and normalize data from a wide set of sources across the healthcare continuum. SCIO’s advanced analytic platform then helps organizations identify, risk stratify, and leverage predictive modeling. SCIO’s platform analyzes claims from within patient populations to identify actionable care gaps, design effective programs, and meet value-based care delivery initiatives.

A recent webinar presented by SCIO with Oracle Health Sciences, Payer Provider Convergence: Using Data to Strengthen Partnerships & Drive Outcomes explored how payers and providers can share/analyze to increase collaboration and work toward improved health outcomes. More specifically, the presentation provided insight into how payers and providers can leverage data and analytics to advance goals such as:

  • Managing Risk and Revenue
  • Optimizing Reimbursement
  • Improving Quality and Compliance
  • Optimizing Provider Networks

To learn more contact SCIO Health Analytics at info@SCIOhealthanalytics.com or Oracle Health Sciences at healthsciences_ww_grp@oracle.com.

Reference

1. Society of Actuaries. Predictive Analytics in Healthcare Trend Forecast. https://www.soa.org/Files/programs/predictive-analytics/2017-health-care-trend.pdf

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Author
David Hom
Chief Evangelist

Dave is an internationally-recognized expert in the field of consumer engagement through programs such as Value Based Benefits and Employee Wellness.

Read full profile and other posts |

Author
Lesli Adams, MPA (Guest Author)
Director of Population Health Strategy, Oracle Corporation

Lesli has a strong background of driving healthcare technology strategies for Oracle, Tenet Healthcare Corporation and the University of Texas MD Anderson Cancer Center.

Read full profile and other posts |

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