Health care stakeholder interactions often become a “zero-sum” game with one stakeholder’s gain or loss balanced by the gain or loss of other participants, according to Jason Williams, vice president of clinical analytics at the RelayHealth transactions processing unit of McKesson Corp.
In the zero-sum game, aggregate gains and losses are either more or less than zero, Williams explained at Health Data Management’s Healthcare Analytics Symposium. Suppliers and providers drive the costs of quality to funders, such as insurers. Funders, in turn, transfer risk to other stakeholders via pay-for-performance. But now, all stakeholders, including consumers, are heading toward aggregate losses, he contended. “None of these stakeholders are looking at a bright, positive world.”
Manufacturers faced a similar future until they looked at finding value outside their own organizations and between stakeholders, and now health care must do the same, Williams contended. And the manufacturing industry turned to data analytics to pave the way for more balanced collaboration. Medical device manufacturers, for instance, knew how much product they sold, but not underlying distribution chain inefficiencies or problems that buyers were having with their products--both of which adversely affect revenue.
Analytics helped identify manufacturing issues and solutions, and can do the same in health care, Williams said. Health insurer payment rules, for example, can be analyzed to find bottlenecks in transactions processing that delay reimbursement. The new Office of Information Products and Data Analysis in the Centers for Medicare and Medicaid Services has resources, including government data, to get started, he added.
Along with resource help, providers and other industry stakeholders need to change their mind sets, Williams said. They must seek stakeholder gains, more cross-stakeholder information transparency, and new ways to encourage inter-stakeholder coordination.
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