Guest Column | June 5, 2017

Real-Time Healthcare Data: A Game Changer For Navigating The Care Path In The Bundled Payment Era

By Brad Josephson, Director of Marketing and Communications at PMMC

Brad Joesphson

Population Health Management and Bundled Payment Models have created a high demand for innovation in healthcare information technology. Healthcare providers have historically operated in silos, but value-based care initiatives have highlighted benefits for looking at healthcare comprehensively and are financially structured to transform care accordingly.

Here’s a look at the different stages in which healthcare has transformed and adapted to the increasing demands for modernized information technology software.

Stage 1- Age Of Predictive Analytics
In the early stages of this transformation, it was clear providers needed data to understand episodes of care and the types of populations being managed. Vendors in the healthcare IT space raced to the market with analytics using historical episodic data. Providers shifted from looking at their internal data to viewing it across the entire care continuum. Predictive analytics became essential tools to understanding the risk involved in alternative payment models (i.e. Medicare bundled payments) and the healthcare IT industry fulfilled this demand quickly.

Stage 2- Age Of Real-Time Patient Tracking
The next wave of innovation is real-time patient tracking. Providers want the ability to intervene when patients veer off the desired path of care and this requires monitoring the patient across the continuum of care.

This is a much more complex task given that the healthcare industry does not have the infrastructure to effectively share medical information and communicate across different healthcare information technology systems. Without connected data, increasing collaboration among multiple levels of clinicians is a challenge.

Stage 3- Modern Day- Age Of IT Integration
Today, a few providers have partnered to share data as close to real-time as they can. Many other providers solve the real-time patient tracking challenge through patient navigators and manual tracking. With the expansion of bundled episodic payment models, the increasing number of tracked patients will require additional navigators and will create a need for automated patient tracking.

Currently, tools are available that allow care navigators to enter patients into a system which then auto-populates the budget for each care setting based on the defined bundle and historical payments. As the patient moves through the path of care, the navigator can measure the actual episode to date versus budgeted payments. This blend of real-time information and predictive analytics highlights areas where navigators and management may want to intervene quickly to reduce spending within episodes of care.

In addition to tracking spending, bundling analytics will soon have the ability to track new payment and service delivery models, helping hospitals navigate the regulatory complexities that result from overlapping models. This includes areas such as the beneficiary disclosure process, discharge planning process, 3 Day SNF Waiver process, etc. This is key functionality for hospitals that are participating in both ACO and alternative payment models.

Once healthcare data is connected, there will be a need for solutions to extract value from this data. The speed in which the data can be collected from all touchpoints, consolidated, and turned into actionable analytics will be crucial. Timely, meaningful data will open the door for predictive analytics and evidence-based treatment options for patients.

At the end of the day, real-time healthcare data presents a huge opportunity for navigating the care path. By focusing on patient-specific analytics, healthcare providers can feel more empowered to make informed clinical decisions at the point of care to revolutionize patient outcomes, while at the same time bending the cost curve of healthcare.

About The Author
Brad Josephson is the Director of Marketing and Communications at PMMC, a provider of revenue cycle software and contact management services for healthcare providers. Brad received a Bachelor of Arts, Public Relations and Marketing Degree from Drake University. He has worked at PMMC for over three years and has a deep knowledge of revenue cycle management tools which improves the financial performance of healthcare organizations.