TREND #1: ALIGN CLINICAL, QUALITY AND FINANCIAL ANALYTICS TO ENABLE VALUE-BASED CARE
Healthcare organizations today are being challenged to reduce costs, improve care coordination and outcomes, be patient-centric, and provide more with less. And they are doing all of this while trying to adhere to regulatory requirements and untangle the entrenched web of inefficiencies that negatively impacts both progress and, ultimately, clinical outcomes.
One change that is directly impacting healthcare providers is the transition from a volume-based (fee-for-service) to a value-based care delivery model. Value-based care requires reporting hundreds of process and performance measures to various quality and regulatory programs, like the Medicare Shared Savings and Pioneer ACO programs, in order to be reimbursed. The Patient Protection and Affordable Care Act (ACA) changes provider reimbursements by focusing on the Triple Aim: improving the health of the population, enhancing the experience and outcomes of patients, and reducing the cost of care. Medicare reimbursements are based on value, not volume. This means hospitals and physicians will see their payments modified so that those who provide higher-quality care will receive higher payments than those who provide lower-quality care. For example, looking at just the value-based purchasing adjustment, which incorporates a number of quality measures, Definitive Healthcare estimates in 2015 there were 100 hospitals that received more than $250,000 in additional revenue, and nearly 130 hospitals that were penalized more than $250,000.
To avoid these penalties, it is critical for healthcare organizations to unite quality indicators and measures with clinical analytics that drive operational performance. Care delivery teams within healthcare organizations are dependent on high-quality data in order to make timely decisions that positively impact the outcomes of the individuals, organizations, and communities they serve. By truly harmonizing clinical analytics and quality indicators, healthcare organizations can move from reactive reporting to proactive and actionable insights that uncover process improvement opportunities in real-time.
This is just one of the healthcare analytics trends for 2016. In our new guide, we take a look at ten analytics trends healthcare executives need to be thinking about in 2016 and beyond. We identify technology strategies and solutions that will help healthcare organizations succeed in a data-driven, digital world.
