Practical Analytic Approaches to Healthcare Challenges
Technology continues to advance almost daily and data sources and real-time data access are rapidly expanding in healthcare. These advances, combined with the shift from fee-for-service to value based reimbursement, mean healthcare analytics and reporting are changing too, and access to timely data is critical. But do all these advances and changes call into question the utility and value of monthly retrospective data for provider analytics?
The short answer is no.
There are advantages to real-time (or near real-time) data and there are advantages to retrospective data. The two can, and should, peacefully co-exist and complement each other.
There are certain critical analytics, including financial analytics, which require more static retrospective data to support strategic and long term operational decisions. Retrospective data also affords the opportunity to analyze and learn from how patients were managed in the past, which will benefit both providers and patients.
Examples include but are not limited to:
- Utilization Efficiency Analysis and Cost Savings Opportunity Identification - This can include statistical analysis comparing against internal and industry accepted benchmarks and established guidelines.
- Provider Efficiency – Using historical data to identify providers who are less or more efficient than their peers. This combined with the ability to drill into the claims detail will provide meaningful insight to both cost and utilization efficiencies while also considering the risk burden of the population.
- Trend Reporting – Analyzing historical trends across time periods and targets. This could include cost, utilization, population changes, including member demographics and chronic populations.
- Care Management Program Efficiencies - Understanding the effectiveness of programs from a cost and resource utilization perspective on the outcomes of patient health.
- Population Health Management – Broad analytics that can identify the most impactablesegments of the population, identify avoidable waste, target and prioritize member populations for care management interventions, and target providers for education opportunities, as well as many other critical use cases.
In contrast, real-time (or near real-time) operational reporting or analytics is better suited to the following needs:
- Ability to access the most up-to-date clinical information. - This means clinicians can assess patient-specific eligibility, gaps in care, lab data and other EMR related data.
- Allowing users to be alerted to important data changes or where thresholds (KPIs) are exceeded in real-time.
- Situations where users need to quickly view, analyze and drill down on real time displays, or dashboards in real-time.
Being able to support a broad range of use cases with both retrospective and real-time data allows an organization to be more competitive, adaptive and gain more strategic and operational insights to their performance efficiencies and improvement opportunities. Clinicians benefit by having the ability to make better-informed decisions at the point of care, a key factor in providing the most appropriate care for their patients.