Market data provides better picture of total cost of care

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Value-based care places new pressures on healthcare organizations to improve performance, and data plays a crucial role in making improvements. However, most organizations have a limited sample size of a patient’s care and the related information about their experience.

Most notably, providers have struggled to make improvements by comparing their performance with what other provider organizations are doing. And finally, they lack sufficient information to bargain intelligently with payers in discussions on rates and performance under value-based contracts.

“There are challenges in working with payers—we have our data and they have theirs, and reconciling between the two can be a challenge,” says Ed Beranek, vice president of revenue management and reimbursement for Johns Hopkins Health System.

The Maryland-based delivery system worked with a long-time vendor, KPMG, to take the results of a national claims database to gain insights that led to improvements in operations and the ability to better negotiate with payer organizations.

Beranek and James Case, director at KPMG, will lead an educational session at HIMSS18 entitled, “Using Market Data to Move the Needle on Performance.” In their presentation, they’ll share the importance of using data to understand and manage populations, the total cost of care of those populations, and the relationship with pricing and utilization.

Being able to use analytics against claims data can help an organization analyze and reduce the total cost of care for patients, Beranek says.

Having verified information from a national claims database brought added credibility to discussions with Johns Hopkins clinicians about variations in care delivery, Case says. It also aided discussions with payers who were questioning why some Johns Hopkins costs were higher than those of other organizations.

For example, Johns Hopkins treats epilepsy patients suffering from uncontrollable seizures in a specialized epilepsy monitoring unit, in which they were receiving continuous EEG monitoring. That drove costs higher relative to other organizations treating epilepsy patients, but Johns Hopkins was able to use data to make the case that its patients were sicker, and its results were better because of the use of continuous EEG monitoring.

“We initially took these results to the clinical team and asked them to help us understand it,” Case says. “Unless you knew the patients coming to Hopkins were likely to be uncontrollable (epileptics), you wouldn’t know that the treatment was cost-effective.”

Analysis of a wider range of data also provides insight into the total cost of care throughout the entire course of care, which will become more important in a value-based care environment.

“It showed the power of complete data,” Beranek adds. “Prior to this analysis, we could only look at our small piece of data, where we look at the hospital component of these cases. When we look at the entirety of care, we can better determine what is generating the total cost.”

The educational session will begin at 2:30 p.m. on Wednesday, March 7 at Palazzo K of the Venetian Convention Center.

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