By Dan Rizzo, CIO, Inovalon
There has been a lot of talk about transforming healthcare into an industry that leverages real-time analytics. Sadly, while the cost of a purchased cup of coffee at Starbucks appears on your iPhone in seconds and your 401k reflects every change in holding and values at any given moment, healthcare has not made it easy for clinicians to leverage similar technology. In fact, patients and physicians are often left in the dark for months after clinical events, greatly limiting the industry’s efforts to improve quality and efficiency. The infrastructure is there, and so is the technology. The only thing left is a company that will engineer the software itself.
Why Are Real-Time Healthcare Data Analytics So Important?
Too often today, healthcare information is disconnected and not readily accessible in a centralized, informed manner, greatly limiting the industry’s efforts to improve quality and efficiency. Real-time analytics tools address this issue head on by bringing disparate information from many sources into the one place it’s needed most — at the point of care, in real time where the benefits can truly be life-saving.
The information gained from analyzing massive amounts of aggregated health data can provide actionable insight to improve operational quality and efficiency for providers and insurers alike. This increased efficiency is necessary in a healthcare industry rapidly transitioning from volume- to value-based healthcare. Now more than ever, it is critical clinicians and providers can identify and address gaps in care, quality, risk, and utilization to support improvements in clinical and quality outcomes and financial performance.
Real-Time Data Analytics Can Change The Way Healthcare Is Delivered
The shift from volume- to value-based care has realigned the priorities of clinicians, providers, and insurers. Real-time healthcare analytics can help improve the quality of care, cut costs, and meet regulatory requirements by automating and streamlining the process of collecting and measuring massive amounts of healthcare data.
Clinicians want to achieve high quality results and/or are part of an organization that is incentivized to achieve high quality scores. The problem now is there is no way for a physician to determine specifically what the quality measures are to achieve a high score and what the patient has already achieved vs. still has outstanding to achieve a strong score. Real-time analytics can provide a real-time report outlining where a patient stands and how to improve their quality, achieve compliance and realize full reimbursement for their services.
In addition to the frustrations clinicians face in measuring the quality of their work, they are challenged by the lack of access and insight into the medical history of their patients (which can impact the quality of care they can provide to a patient). Making matters worse, many EHRs are poorly interconnected and/or the data simply takes too long to make its way through the system. Real-time analytics will provide instant and accurate insight into patents’ medical history — including past clinical conditions, diagnoses, treatments, utilization, and outcomes – even if they occurred in the ER of a resort town across the country. The information can help direct appropriate care and reduce unnecessary costs.
Clinicians often have limited insight into all of the patient’s disease and comorbidity status, and little time or expertise in risk score coding accuracy requirements. This misalignment can significantly impact the accuracy of documentation, associated claims data, risk score accuracy, and related reimbursement for health plans and/or ACOs. Real-time analytics can provide insight into historical, current, and predictive risk score-accuracy gaps to support accurate disease burden documentation and treatment of unaddressed and worsening conditions that need the clinician’s attention so that problems may be addressed before the patient is readmitted and the hospital is penalized.
Similarly, health plans and providers struggle to avoid duplication of tests, because they don’t have full insight into how often or how recently similar tests have been ordered. They often don’t have insight into the patient’s benefits parameters for care considerations. Real-time analytics aid clinicians to identify unnecessary utilization and costs related to tests and benefits coverage guidelines under the patient’s insurer to avoid duplication and less costly alternatives.
It is important to be aware of care management resources a patient may be eligible for, but it is often impossible for clinicians to track which federal, state, and healthcare organization-specific programs are available. Real-time analytics provide clinicians program eligibility insight that accelerates the engagement of the right patients, ensuring enrollment in the right programs, at the right time to help improve care and decrease costs.
Who Will Benefit From Real-Time Analytics Delivered At The Point Of Care?
All sectors of the industry would benefit from real-time analytics because this allows provider and insurers alike to get a better picture of the patients that they are caring for.
Clinicians will benefit as they will be able to make better-informed decisions at the point of care, a key factor in providing the most appropriate care for their patients. Clinicians have dual challenges: to deliver high quality care in an increasingly complex healthcare environment, and increasingly be mindful of factors impacting performance goals such as utilization efficiency, objective metrics, and healthcare economics. Real-time analytics allow clinicians to quickly gain insight into their patients in ways that empower them to save time, improve care, and achieve critical metrics that impact their financial performance.
Real-time analytics offer health systems the ability to access the most up-to-date information. This mean providers can assess patient-specific eligibility, gaps in care, risk scores, and historical medical information at the point of care — all of which can be easily integrated into their existing operational model — to help improve quality performance, ensure regulatory compliance, avoid waste and reduce cost.
Real-time analytics support health plans, ACOs, hospitals, integrated care delivery systems, and physician organizations who are engaged in capitated, shared-risk, and other value-based arrangements. Health organizations must demonstrate they provide quality care to their patients. The insights from these analytics help health organizations of all kinds achieve and benefit from superior quality scores, comprehensive and accurate risk score data, improved utilization efficiency, and greater coordination of care.
Last, but certainly not least, real-time analytics benefit patients because it supports their goal of receiving superior quality care at a lower cost by giving clinician a more informed view of the patient’s comprehensive medical history. This helps clinicians minimize redundant or unnecessary testing, which a physician can only be certain of if he has the right information at the right time.