Providers have relatively little experience analyzing clinical data, and as a result, they’ll be put to the test as payers establish stiffer quality metrics that increasingly are being tied to reimbursement levels.
Beyond that, providers will need to show they can take action on data to achieve measureable improvement in quality, says Brian Murphy, industry analyst at Chilmark Research and lead author of a new report assessing the analytics market for population health management.
While providers need to report quality indicators to get paid, “whether they actually are producing increased quality is not yet a foregone conclusion,” Murphy says.
Providers can expect Medicare and other payers to increasingly look more seriously at outcomes when it comes to setting payment rates, Murphy cautions.
As time goes on, providers will face more pressure to demonstrate quality gains, and that will be challenging because most of them have only had a short-term focus on where the next dollar comes from, Murphy contends. Healthcare organizations are being forced to change their perspective to focus on clinical improvements by new reimbursement initiatives, such as Medicare’s bundled payments for the Comprehensive Care for Joint Replacement program and the Bundled Payment for Care Improvement Initiative, which combines payments for services from provider organizations to cover a single episode of care.
Consequently, providers need to start looking beyond simple quality reporting and prepare to use analytics in new ways to assess outcomes. That’s being done by large and well-funded delivery systems, such as Geisinger Health System and Kaiser Permanente, “but the average integrated delivery system and community hospital just isn’t there yet,” Murphy says.
To do the complex analytics that this will require, providers will need a mix of information technology that support data exchange, such as using application programming interfaces and the emerging FHIR interoperability standard of HL7. This transition will be difficult for many community hospitals, which will need to find additional money, expertise and bandwidth to achieve these advanced analytics efforts, Murphy says.
According to Chilmark, the good news is that electronic health records vendors have made strong progress in their analytics capabilities during the past year and are starting to release robust analytics modules. For many providers, using analytics capabilities from EHR vendors will be path of least resistance—they are a known entity and have an advantage over analytics vendors in understanding clinical data, Murphy explains.
There are a slew of pure-play analytics vendors that excel at handling multiple types of data. Providers may be able to strike better deals with these vendors because they are anxious to gain customers, and that’s leverage that providers aren’t likely to have with their EHR vendors, he added.
The Chilmark report, “The 2016 Clinical Analytics for Population Health Management Market Trends Report,” is available here, free to subscribers and costing $6,000 for others.
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