As healthcare organizations engage in accountable care initiatives they will turn to analytics as a linchpin. Analytic strategies require key attributes or fundamentals.The fundamentals include: transparency in processes and analytic methodologies, domain knowledge of all data sources, ecosystem members agreement to use the same data, knowledge of and experience in risk assessment methods and tools and reimbursement model development.
Most accountable care initiatives include multiple stakeholders and as such they must agree to a certain level of transparency both in processes and data. Too often, particularly with health plan and provider contracting every party comes to the table with a different set of data which rapidly turns the discussion into one about data accuracy not about terms and conditions of the relationship. One of the key contributors of previous reimbursement and business model failures in healthcare was due to the lack of transparency and tools. Transparency and consensus particularly on reimbursement and performance measurement will be critical to success.
One of the great challenges facing accountable care initiatives will be around the data. The data must include access to both health plan and provider data. Clinicians will need access to clinical and claims information in order to understand utilization that may be occurring outside of the networkf and the risk profile of their patients. Analysts will need to access both clinical and health plan data as they identify and manage risk, performance measurement will include both cost and quality measures. Health plans must prepare to share data for these accountable care initiatives. Organizations involved in accountable care initiatives will need to have analysts with experience in all sources of data, these individuals will have responsibility for reconciling data quality issues and advising other analysts on data interpretation. There will also need to have experts in the business and clinical uses of the data.
Ecosystem members must agree to use the same data and methodologies in instances where there are similar uses of the data. This will be critical to the development of trust between health plans and providers. Data wars must be avoided at all cost. This will require a well thought out policy on data access and data interpretation.
Risk identification and segmentation methodologies are fairly routine for health plans they may well be a new domain for individuals who have typically worked in a provider environment. Historically, risk identification was accomplished using claims information with standard grouping methods such as Episode Treatment Groups and Diagnostic Cost Groups. With the availability of clinical data there will likely develop new approaches to risk identification and prediction.
The advent of new provider reimbursement methodologies will require new domain expertise as well as the use of new data sources. Transparency will again be key to moving these new approaches forward. While provider organizations have been the recipients of the results of reimbursement methods developing an approach may well be a challenge.
Organizations that engage in accountable care programs will quickly realize that analytics is a key requirement. Developing a strategy that takes into account the issues raised above will move the organization to success. The need for health plans and providers to work together collaboratively will move these initiatives forward at a faster pace.
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