The Role Of Analytics In Making The Switch To Outcome-Based Healthcare

By Dr. Vegi , Wipro Limited

Data and analytics have always been central to healthcare. Now, however, a major shift in how data is generated, aggregated and used is underway. The shift promises to turn data into the equivalent of a new performance enhancing drug, powering the industry towards evidence-based care and new outcome-based healthcare business models.

The nature of the shift is deceptively simple. Participants in the industry, from patients to providers, to payors, pharma and device manufacturers, are coming together to share and analyze patient data to fully understand the patient journey. With this understanding, they can take steps to improve patient care, there by impacting health outcomes.

The following growth drivers of data analytics in healthcare provide us with indicators of where the industry is headed.

1. Regulatory compliance. Accountable care organizations (ACOs) are spearheading the cause for evidence-based treatment and outcome-based care. Adherence to ACO standards provide financial incentives and penalties based on performance. In order to meet ACO standards, physicians and care givers must answer questions such as: “What treatment should we provide? How much time will the patient take to recover? Are remissions likely? Will the patient require re-admission to hospital? How can adverse events be avoided? How can duplication of services be avoided? What will be the cost of care?” The key is to integrate data across physicians, clinicians, hospitals, laboratories, imaging systems, electronic health records (EHRs), payors and wearables. When done, analytics will provide a clear and dependable view of treatment and efficacy.
2. Change in the doctor to patient ratio. Physicians have traditionally used their training, experience and judgment to arrive at a diagnosis and treatment decision. However, now they can supplement their expertise with data. This would be good, were it not for the fact that the growth of data is too fast and complex. The Stanford Medicine 2017 Health Trends Report suggests that digitization of healthcare is currently the fastest growing segment of the digital universe, responsible for 48 percent yearly growth in data, compared to the average growth of 40 percent per year across the digital universe. Without sophisticated analytical tools, data places a mammoth cognitive load on physicians. Fortunately, analytics is stepping in with clinical decision support (CDS) systems to ease that pressure. CDS tools organize and present data for clinical and diagnostic guidance, flags patient-specific disorders and allergies, and provides insights into optimal treatments.
3. The availability of low cost technology. The growth in more affordable technology could not have happened at a better time and is proving to be a boon for the healthcare industry. EHRs have traditionally been maintained by capital intensive legacy systems. Today’s low-cost technology—cloud, software as a service (SaaS) and infrastructure as a service (IaaS), etc.—is putting affordable and scalable tools into the hands of care providers. More importantly, from a data and analytics point of view, the technology is also driving greater transparency, making it possible for payors and regulators like the Centers for Medicare and Medicaid (CMS) to use EHRs for compliance. The growing access to reliable data has already encouraged around 70 percent of payors in the US to move to outcome based plans. For patients, the upside of the data glut is just as striking. Payors are offering plans that are specific to their conditions, such as therapeutic plans for infectious diseases, respiratory and cardiac issues. This change is revolutionary for patients who have had no option until now but to pay vast amounts for broad medical insurance that doesn’t necessarily benefit them.
4. Better treatment plans in collaboration with pharmaceutical organizations. With access to broader and deeper data, pharmaceutical organizations can come up with better formulations for diseases. Having said that, the immediate outcome is of greater interest. With data and analytics, pharmaceutical organizations will be able to confidently provide assurance around their formulations. This will shift the trend from volume discounts to evidence-based outcome models.

Doubtless, there is an urgency in the industry to adopt analytics. But the urgency can result in uncertainty and chaos such as: applications talking to one another across organizations and over a variety of networks and platforms; traditional ways of exchanging data are bypassed, raising security risks; and there are difficult-to-answer-questions such as: Who owns the data, the care provider or the patient? Who provides the authority to share the data?

These are not intractable issues. The industry will ultimately find answers using data masking techniques, advanced security measures, and patient permissions. What is certain is the march of analytics as the next big trend in healthcare. It has the power to transform medical care as we know it, leveraging the full potential of technology to improve health outcomes.

About The Author

Dr. Vegi is Head of Integrated Solutions and Architecture, Health Business Unit for Wipro Limited.