Driving Value-Based Success through Advanced Analytics Tools for Payors and Providers

In order to be successful with adopting value-based care (VBC), payors and providers alike must leverage the data they’re collecting. The problem is that the data comes from a variety of disparate sources, and unifying and standardizing it so that it’s not only easy to view but understand and act on, is a major challenge. 

In this article, we’ll take a closer look at how payors and providers can use data to improve performance, control costs and improve health outcomes through advanced analytics tools. Here’s what to know: 

Understand VBC 

VBC represents a marked difference over the traditional fee-for-service model by focusing on the quality and delivery of care rather than how many services were delivered. Under the VBC model, success is defined as how well healthcare organizations meet specific performance metrics, including patient outcomes and overall satisfaction as well as cost savings and access to care. 

For payors, this means designing contracts that incentivize quality. For providers, this means delivering the highest-quality care evidenced by improved outcomes. Traditionally, aligning these two very different stakeholders has been a challenge. Both payors and providers need a shared understanding of population and performance data in order to maximize every dollar spent and turn that spending into measurable improvements in patient care.

This is where the right advanced analytics tools come into play. Advanced analytics break down data silos and generate actionable insights that both parties can understand, adapt to and work with. 

How Can Advanced Analytics Optimize VBC?

Advanced analytics solutions consolidate data from different sources, including:

• Electronic Health Records (EHRs)
• Claims databases
• Lab systems
• Surveys that collect social determinants of health
• Wearables and other diagnostic devices

All of this information flows through a unified, single, secure environment, providing a “single source of truth” which enables both payors and providers to manage health-performance metrics in real-time. 

Healthcare data is often scattered across many different systems, each of which has its own format and configuration. Advanced analytics tools standardize this data which makes it both accessible and actionable. This standardization in turn allows stakeholders to quickly identify trends, understand health outcomes and highlight areas that may require intervention.

For example, a hospital may have patient data stored in an EHR system, but claims information is stored in a separate billing system while population metrics are in yet another database. Without the right kind of integration, getting a complete picture of care delivery is complex, complicated and prone to errors. An advanced analytics solution bridges these gaps and brings in every piece of data – creating a more holistic view and understanding of overall health status, as well as the granular details that drive it. 

Near Real-Time Monitoring and Predictive Insights

With the traditional fee-for-service model, healthcare leaders would have to wait for periodic reports which were often outdated by the time they arrived. This meant that any problems would be solved with a reactive, rather than a proactive approach. Having immediate access to current, relevant data means that leaders can better understand drivers of cost and care, resulting in effective, data-driven decisions, especially for at-risk segments of the population. 

Predictive analytics takes this idea a step further. Using the latest technology, including artificial intelligence and machine learning, predictive analytics looks at historical and current data and forecasts future outcomes, plus any potential challenges that may surface. For instance, such tools could predict patient readmission risks, uncover care gaps and estimate the financial impacts on VBC contracts, giving payors and providers the ability to plan and act more strategically for the weeks, months and years ahead. 

Real-World Applications Using Advanced Analytics

A major health plan which was responsible for managing a variety of VBC contracts, integrated data from its EHRs, claims systems and population health databases into a single, unified dashboard. Having a singular view allowed the payor to monitor member utilization, identify gaps in care and uncover cost-saving opportunities. 

A multi-hospital system faced challenges with fragmented data, which made it difficult to track patient outcomes across different facilities. By utilizing predictive analytics and implementing an advanced analytics solution, the hospital system was able to consolidate patient data securely from various departments, as well as external sources. This gave the hospital system a detailed view of patient trajectories, from admission to discharge and beyond. With this level of insight into readmission risks and care gaps, the hospital system could coordinate follow-up care more efficiently, lowering readmission rates and improving patient outcomes. 

The role of advanced analytics in VBC is only going to grow from here. As artificial intelligence and machine learning become more sophisticated, they in turn affect the quality of predictive capabilities – allowing for even more precise forecasts and more targeted interventions. Data integration will be improved by way of better interoperability standards, which will allow organizations of all sizes to take advantage of this powerful and easy-to-use technology. 

What’s more, the shift toward patient-centric care will make it even easier to incorporate patient-generated data, including information from wearables and mobile health apps, into an advanced analytics solution. This gives payors and providers an even deeper, more granular view into patient health, so that they can tie interventions more closely to each individual’s needs. 

Gray Matter Analytics, with its commitment to creating a more unified,  robust advanced analytics solution, will be at the forefront of this change. Through our powerful CoreTechs® solution, we’re setting new standards for how advanced analytics drives VBC success for both payors and providers. Learn more about how our advanced analytics tools are driving success for healthcare organizations in a VBC environment.