Information is impacting Providers, Payors, and Consumers
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The Information Impact on Providers, Plans, and Consumers

Over the better part of the last decade, most healthcare organizations have significantly invested into technologies like EHRs with Care Management and Population Health support. These investments have equipped their healthcare practitioners with accurate information about their patients necessary to provide timely and appropriate quality clinical care to their patients. Certainly, CMS helped influenced some healthcare institutions into this type of technology adoption by continuing to influence pay-for-performance (P4P) over fee-for-service (FFS) practices via payment incentives and penalties through programs like Meaningful Use, Value-Based programs (HVBP, HRR, PVBM, HAC, ESRD, SNFVBP, and HHVBP), and APMs / MIPS (made available via MACRA). Whether being a forward-thinking organization or one that was incentivized into doing so, the end result is that many healthcare organizations are positioned better now, then even just a few years ago, with the infrastructure they need to obtain insights into a multitude of performance areas that directly impact their bottom-line and subsequently how they could be perceived in the market.

With this said, healthcare organizations need to remain acutely aware of this very dynamic and ever-changing market that is right in front of us. For one thing, consumerism is here, and it is here to stay. Today’s patients and members expect to be more actively involved in their care decisions as well as more willing to comparison shop for services and service providers not only because they are incurring more of the cost of healthcare services, but also because information about care providers and care services options is more readily available. However, navigating and consuming the information that is available can be extremely time consuming and overwhelming. This is where healthcare organizations have the opportunity, through initiatives like Population Health Management and the institutionalizing of Patient 360 / Member 360 programs, to differentiate themselves by developing and executing a more proactive and personalized relationship with their consumer.

Similarly, the informational relationship between healthcare provider and health plan needs to continue to progress towards full transparency. As Congress continues to review options to address issues with the ACA including allowing for participation in health associations across state lines plans and expanded HSA contributions, providers and health plans will need to work ever-more-closely together to deliver appropriate and timely care is to its patients / members. Through collaborative activities like utilization reviews and truly understanding contract performance, both parties have the information available to effectively communicate and correct any processing anomalies to directly impact the increase of “clean” claims and accelerated payment. By operating with aligned priorities, this “processing partnership” creates more confidence and comfort to engage in shared-savings / risk-sharing / risk-adjusted agreements including bundled payments and ACOs versus health plan-owned-risk-arrangements, e.g., fee-for-service agreements, or provider-owned-risk-arrangements, e.g., capitation agreements. And, in some cases, where the local market and organizational attributes present opportunity, value-based health care has created an environment for providers to consider offering provider-sponsored health plans as a competitive solution to locally available health plan products.

The reality for today’s healthcare organizations is that in order to address the informational demands of today’s consumer and business operations, they need to continue to develop and execute effective business intelligence and Connected Health strategies. Traditional systems like EHRs and ERPs still and will always process essential data for users, but IoT has presented new opportunities / challenges that cannot be overlooked. Therefore, any data strategy will need to be able to address the availability of structured data as well as unstructured data and present information via easy to understand dashboards and other visualizations, e.g., enterprise data warehousing, Data Lake, NLP, and potentially Machine Learning solutions. Bottom line, Healthcare organizations need to remain proactive in their approaches to listen, understand, and address the informatics needs as they present.

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