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The role, and actual meaning, of analytics in healthcare

By Ric Sinclair L

ike the phrase Big Data, the term analytics means diff erent things to diff erent audiences, and both ap- pear frequently in vapid, buzzword-rich pronounce- ments about the inevitable future of practically

everything, which only adds to the confusion. So instead, try thinking of analytics as meaningful visibility.

It is a resource to help you make smarter calls on the decisions that can’t wait, and a source of insights into the otherwise unknown specifi cs of what’s driving long-term fi nancial per- formance and population health. Complex healthcare organizations (HCOs) need two types of visibility: horizontal visibility, meaning comprehensive ag- gregation of data across their entire enterprise, and vertical visibility, meaning easy access to the details driving their HCO. In today’s turbulent healthcare environment, waiting for these forms of visibility isn’t a viable option. T ankfully, and despite what you might have heard, this

level of analytics isn’t dependent upon overhauling your data systems or building enterprise data warehouses. Much of the data you need is already available within your existing systems, and cost-eff ective forms of cloud-based technology already exist that make that data accessible and actionable, today.

Smarter decisions in the immediate and near-term Healthcare executives can’t delay making decisions that

directly impact or dictate their organization’s fi nancial health for the following quarter, six months or fi scal year. Whether it’s fi nalizing the annual budget or negotiating payer contracts, piecemeal information on fi nancial performance increases the risk of bad, or at least suboptimal, decisions. And when it comes to payer contracting, lack of visibility also weakens your negotiating position. At the day-to-day level, analytics shows you where to focus

your training and can help you prioritize staff time and other resources. It enables you to understand the details of your revenue cycle and A/R days, and see the historical and near- real-time diff erences between individual actors: which payers have the longest turnaround times for claims, for example, and which coders have the highest denial or rejection rate. Analytics empowers you to catch and address problems in your reimbursements before they become entrenched and erode a signifi cant slice of your revenue. Eff ectively analyzing data across your enterprise provides a clear picture of how changes and trends in the near-term aff ect your organization over time. Without those abilities, you’re

20 June 2014

Ric Sinclair, Head of Product, ZirMed

fl ying blind toward a future that looks like ... what exactly? T at’s the point. If you don’t know, you can’t plan eff ectively. Let’s take referral patterns as an example. Analytics not only

enables you to manage referral leakage and total cost of care, it’s one of your best sources of information for long-term acquisi- tion and affi liation planning. Are patients being referred out of network for specifi c types of care? Do you have a suffi cient number of specialists in your network to meet that demand? Where are the out-of-network providers located, and do you have good coverage in those areas? T ese insights can help you make business decisions that better serve your patient popula- tion while also keeping more care in-system. T at touches on perhaps the most important role of ana- lytics in healthcare: supporting value-based reimbursement. Aspects of revenue cycle analytics (like the referral example

above) are already making their way into population health management eff orts. Revenue cycle analytics can be especially valuable for managing population health and keeping a handle on costs, because the data it relies on is readily available and includes fi nancial data as well as information on procedures and diagnoses. T e overlap creates opportunities for HCOs to make smarter use of their resources, set standardized population health benchmarks and track improvements on outcomes to show, for example, reductions in emergency events for patients with disease management needs, or to easily track the comple- tion of follow-up care regimens. Revenue cycle analytics is a resource for increasing the ef-

fectiveness of disease management, in part because it’s built on standardized, increasingly scrutinized data, but its ability to support improved outcomes extends far beyond spotlighting near-term opportunity and risk. Analytics lets you see the inner workings of your HCO in a way that leads to better outcomes on multiple fronts: optimized fi nancial performance, wise and forward-looking operational decisions, and improved patient and population health. Whatever the future looks like, the only way to make it brighter is to shine a light on where you are and where you’re headed. T at’s why HCOs can’t wait around for analytics.

HMT editor’s note:We will trace the principles outlined

above in action as we follow active ZirMed projects over the next several months. Our fi rst ZirMed Living Case Study up- date will be posted in the “Online Only Features” section of the HMT website in June.


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