Improving Utilization Management with Advanced Analytics to Enhance Outcomes and Reduce Costs
In order to improve patient outcomes and maintain high standards of operational efficiency, utilization management has become a core focus of many healthcare organizations. As new demands surrounding value-based care become more common and payors, providers and state agencies shift to this standard of care, up to date advanced analytics begins to play a crucial role in how data is collected and how that information is used to drive smarter decision-making. Here’s what healthcare organizations need to know to stay one step ahead of the changes.
Utilization Management from Past to Present
In the past, “utilization management” was periodic at best, not to mention complex and cumbersome. Manual audits were fraught with errors and any data reports that were generated were static in nature. Healthcare organizations still relied on this data, but because of the delays, any interventions that were done were reactive and usually ineffective.
Today, the healthcare system is inundated with data from multiple sources, including:
- Electronic health records (EHRs)
- Claims data
- Laboratory systems
- Patient monitoring devices
- Social determinants of health
- Health information exchanges
- Wearable technology and much more
By integrating these different streams into one complete picture, state agencies, payors and providers can all monitor individual and population health status, value-based contract performance and organizational financial health continuously and course correct proactively or as the need arises.
Given the speed with which healthcare technology and patient needs evolve, it’s more important than ever to invest in powerful, complete yet easy-to-use analytics solutions which can take these data points and turn them into actionable insights that improve quality of care and operations efficiency.
Near Real-Time Advanced Analytics: Not Your Ordinary “Batch Processing”
Near real-time advanced analytics is a radical departure from the old “batch processing” methods of the past. Rather than waiting days or weeks for data to be compiled and analyzed (if it is at all), modern analytics solutions continuously update their dashboards as data feeds come in, giving healthcare leaders an always-current, on-demand snapshot of operations.
This type of approach lets them be immediately notified of issues and adverse events, such as sudden spikes in readmissions or unexpected increases in utilization and cost, as they happen. It also allows them to spot potential problems so that they can intervene before those issues become critical.
Continuous, relevant data over time also provides the foundation for identifying trends and patterns in care, spending and more. This is particularly important when it comes to making timely decisions regarding interventions, provider performance and emergency department (ED) utilization.
What to Look For in an Effective Analytics Solution
In order to leverage the full spectrum of resources more efficiently, it’s important to look for the following when it comes to an effective analytics solution:
Data Integration
Data integration is the heart and soul of advanced analytics. Traditionally, healthcare organizations have worked within several siloed systems to capture disparate data. Integrating data from these systems creates a more cohesive, unified profile that has consolidated information from EHRs, claim systems, lab results, etc.
Beyond having a single consolidated source of information, such a solution also reduces redundant data entry while minimizing manual errors, so that all the information that’s being collected and shown is based on reliable and accurate data.
Predictive Analytics
Beyond just monitoring performance, predictive analytics uses both historical and current data to forecast future trends. With the use of sophisticated algorithms and machine learning models, predictive tools can handle everything from estimating patient risk levels to provider network performance and even potential cost savings.
For instance, a predictive model might forecast that certain patient populations are at a higher risk of hospital readmission, which in turn allows healthcare providers to deploy targeted interventions that reduce future readmissions and healthcare costs.
User-Friendly Dashboards
Data is only as useful as the details it provides. Modern analytics platforms present complex information in easy to understand, intuitive visulas through the use of centralized dashboards. These dashboards allow stakeholders at every stage of the process, from clinical managers to administrative leaders, to quickly interpret relevant metrics and highlight any areas for improvement. In short, a well-designed dashboard turns raw data into a kind of visual story that is easily understood and acted upon, if needed.
Real-Time Alerts
Timeliness is crucial in healthcare. Advanced analytics solutions can include real-time alerts and notifications that inform decision-makers when certain limits or thresholds are met or breached. Whether it’s a sudden dip in adherence or a spike in gaps in care, alerts allow for immediate corrective action.
How Gray Matter Analytics Can Help
Gray Matter Analytics incorporates all of these features and much more, helping state agencies, payors and providers manage health outcomes and contract performance more effectively. Through the use of our exclusive CoreTechs® solution, data is integrated from several sources and ingested into one secure, analytics engine. Not only does Gray Matter Analytics track performance metrics, it also uses predictive analytics to forecast trends and highlight potential issues before they become mission critical.
There has never been a better time to start on the path to adopting a fully integrated analytics solution. More than just a technology upgrade, solutions like CoreTechs® represent a fundamental shift in the way today’s healthcare challenges are being met head-on, while staying aligned with future developments.
Technology and the needs of state agencies, payors and providers will continue to evolve, making advanced analytics even more necessary. With emerging trends like artificial intelligence and machine learning, interoperability standards and patient-centric analytics, it pays to be informed and be proactive about changes on the horizon.
We invite you to learn more about how Gray Matter Analytics can help you leverage actionable insights more effectively, while providing a clear snapshot of health outcomes, utilization and cost-saving opportunities, so that your organization can consistently stay one step ahead of the changes that affect the populations you serve.
