August 16 2018 | 0 Comments | 143 reads Average Rating: 3

Ready or Not? Survey Highlights Industry Professionals who Chime in on Risk

by Rose Higgins in Health Analytics

A recent survey conducted by HealthLeaders Media shows that healthcare executives think their organizations are ready to take on the risk that is part and parcel of so many value-based care arrangements. Indeed, 73% of 101 healthcare leaders who participated in the survey said they are “very” or “somewhat” prepared to manage additional risk.

A deeper dive into the survey findings and the opinions of industry thought leaders who participated in a webinar on the topic, however, shows that provider organizations might not be as ready for the risk-based world as their executives think they are.

“I think [they are] being overly optimistic,” said William Aberizk, MD, Clinical Education Administrator, Northeast Medical Group, Yale New Haven Health. “A year ago, I would have said that we were prepared to take on risk, and, I felt comfortable doing it, until we found out all of the data that we didn't really have available to us. With more experience about what data can provide, people might have a different opinion of what they want to do as far as accepting additional risk.”

Donna DuLong, Senior Consultant, SCIO Health Analytics, agreed, and added that healthcare providers typically “don’t know what they don’t know. Taking on additional risk is really about truly understanding the population that you’re managing and knowing as much about that population as you can: the demographics, their conditions, where they seek care, and with whom they seek care, and what types of services they seek,” she said.

Ready or not, risk has become a reality that healthcare organizations must deal with. “We are being pushed basically into accepting risk by more and more payers. We have three Medicare managed contracts and the other Medicare payers want us to accept risk . . . And we're also part of an ACO where risk is very important,” Aberizk noted.

Certainly, Northeast Medical Group is not alone. Consider the following: 81% of respondents are either planning to take on additional risk, have recently assumed additional risk or are currently managing risk for more than two lines of business.

These healthcare organizations could, however, run into problems as only 25% of respondents who use an electronic health records (EHR) system for analytics said that it delivers a “very comprehensive view” and just 14% of those who used a traditional analytics system said it delivers a “very comprehensive view.”

Aberizk agreed, pointing out that his organization’s EHR provides value when it comes to risk management but is not a comprehensive solution. “It's very good for looking at things like quality gaps, how many patients have had mammograms, colonoscopies, diabetic eye exams. But it is not good [at] making sure that we're documenting patient’s problems well. It is really not very effective in helping capture HCC codes,” he said.

Survey respondents also pointed to a variety of obstacles that are preventing them from getting a complete view of risk. They specifically cited a lack of human capital and/or technology resources (63%), fragmented data ownership and data silos (46%) and the inability to look outside of their own organizations/networks (38%).

Want to learn more about the survey findings as well as the ins-and-outs of managing risk? Tune into the webinar entitled “Managing Population Risk: Industry Insights Reveal Key Strategies.”

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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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