5 Business Intelligence TechnologyUse Cases

On the road to value-based care, most recognize business intelligence and healthcare data analytics (BI) as a useful tool in predictive modeling for clinical risk assessment and risk stratification. In addition to these highly useful capabilities associated with managing risk, data analytics in healthcare has other uses as well. In this infographic, we will discuss several other ways BI can be put to good use in navigating the evolution from fee-for-service to value-based healthcare.

Regulatory Compliance Reporting

Total Cost of Care(TCOC) Analysis

Provider Network Efficiency

Claims & Clinical Data Review

Internal Productivity Measurement

On the road to value-based care, most recognize business intelligence and healthcare data analytics (BI) as a useful tool in predictive modeling for clinical risk assessment and risk stratification. In addition to these highly useful capabilities associated with managing risk, data analytics in healthcare has other uses as well. In this infographic, we will discuss several other ways BI can be put to good use in navigating the evolution from fee-for-service to value-based healthcare.

Regulatory Compliance Reporting

The healthcare industry overall and value-based initiatives specifically are monitored against regulatory norms and best practices. These standards, though mandated, pose additional administrative burden on already taxed providers and their staff. In many instances, providers struggle to complete MACRA, MIPS, HEDIS, HCC, and GPRO measures and report acceptable quality scores. Business intelligence/healthcare analytics (BI) technology can help in compliance adherence both retrospectively and prospectively. Retrospectively, the software can point providers to members or patients that are negatively impacting scores so that they get the attention going forward that they need to improve scores in the future. Perhaps more promising than a retrospective view is the potential BI technology has to prospectively identify the cases that require intervention and remediation before reporting occurs thereby preventing a bad or unacceptable score from ever occurring.

Example: Providers can look at diagnosis codes and claims data to determine if higher HCC measures can be used that qualify for higher reimbursements rates and revenue.

Total Cost of Care (TCOC) Analysis

Many healthcare organizations are caught in the middle doing some fee-for-service work and shifting to value-based care in other areas. A critical tool in stabilizing your business is understanding the total cost of care for your population: be it measuring utilization, network usage, 30-day readmissions or trend measurements. The goal is to understand overall cost as it relates to the quality of care and eliminating waste. The TCOC analysis can be used to understand and evaluate costs for your total population, a subset of your population with a defined disease state or diagnosis, or for an individual member of your population. The benefit of the analysis is identifying areas of variation against established benchmarks or measures as well as pin-pointing high-risk population members that need additional attention and / or offer good potential as candidates for care coordination.

Example: Examine trends in the TCOC analysis to determine if the care management interventions that have been added are meeting expectations and leading to the desired outcomes (lower costs, improved health, etc.).

Provider Network Efficiency

Wonder how the physicians in your network are performing overall? Business intelligence and healthcare analytics (BI) data can be used to understand which physicians are performing best on both cost and quality. You can measure against established benchmarks or your systems’ own standards, either way, use BI to get a clear and objective view of your best and worst performers. Additionally, use drill down features to pinpoint issues and opportunities for care and cost improvements.

Example: Your health system has an established care protocol for post-operative care for heart patients. Most cases are resolved without issue, but the provider network data highlights a couple of incidents where there are more than average number of complications and / or infections. A close examination of the data highlights that Physician A is not followingthe established protocol. To follow-up, Physician A is coached on the standard and adheres to the guidelines going forward. The result, patient outcomes are improved, and overall quality scores increase for the entire network.

Interested in going the extra mile to develop a high-performance network (HPN)? To do so, all stakeholders in the ecosystem (providers, payers, TPA, members and any other sources of quality and cost information) must join forces with a common goal of providing the right care, at the right place and right time to minimize risk and optimize cost efficiency. In addition to BI technology, clinical connectivity is critical and choosing a vendor that offers both capabilities aides greatly in your speed to market and adoption of the processes needed to evolve your network.

Claims and Clinical Data Review

A wholistic view of both clinical and claims data is important as both offer insights to critical aspects of value-based care: quality and cost. There are incidents too numerous to mention where both data sets (clinical and claims) are needed to get a comprehensive understanding of a medical case or incident. A few of the most often requested uses are to measure medication and treatment adherence, identify gaps in care, and highlight where intervention is needed.

Example: If implemented and used as part of a total population health management system, BI can deliver messaging and alerts on actionable interventions directly to care coordinators within the care coordination platform for timely execution and resolution.

Internal Productivity Measurement

In addition to regulatory guidelines, frequently healthcare entities have their own metrics or service level agreements (SLAs) to meets. A robust BI and healthcare analytics platform with session timing and time stamp capabilities, can serve as a useful tool to track and measure internal team productivity and operational efficiency. Frequently, entities are interested in tracking and reporting team productivity and compliance with guidelines, analyzing the thoroughness of assessment questioning, identifying gaps or concerns so that assessment questions might be improved, and identifying opportunities for staff development.

Example: A care coordination supervisor notes that the smoking cessation questionnaire is not uncovering reasons why clients have not been effective with past attempts to quit smoking. The supervisor using the BI platform to analyze answers to key smoking cessation assessment questions focused on past attempts at quitting smoking and uncovers opportunities to improve the questionnaire. Subsequently, the questionnaire is updated. Care coordinators use the revised assessment questionnaire and get more insight into how to coach clients and what additional resources would be useful to support clients in their efforts to quit smoking.

These are just a few examples of how BI and healthcare analytics can be used to add value and have big impact on cost, quality and improved health outcomes for your organization. There are many other areas where a BI and healthcare analytics platform can add value.

Have questions or want to discuss these challenges?

Contact eQHealth at eqhealth@eqhs.org or call 1.800.720.2578 for more information.