Dual Analytics the Key to Navigating New Terrain

Jonathan Cook, MBA, PMP
Senior Solutions Manager, Streamline Health, Inc.

As provider organizations adapt to the new realities of healthcare delivery in the US, the need has never been greater for an integrated view of not only the care delivery enterprise but also the interdependencies between the financial and clinical operations. Where a Revenue Cycle Director may have previously focused on optimizing billing, in the future she will also be concerned about clinical quality. Pay for performance requires an understanding of which providers and processes are meeting the thresholds of acceptability, while participating in an ACO or PCMH means sharing the risk with providers over whom you have little or no control. These new drivers require major adjustments to your business model, and organizations are scrambling to assess their current clinical and financial data in a way that yields actionable and predictive insight. And with tremendous financial and human capital investments in their EHR and business office, they must figure out a way forward using as much of their existing infrastructure as possible. Where multiple EHR, billing and ancillary systems are in use, data integration and meaningful analytics can provide the enterprise view needed to address these issues.

To survive, and eventually thrive, through this transition, providers need analysis based on all existing resources—clinical data in their EHR, business and financial data, staff activity and workflows, etc.—in order to deliver insight into how current providers, processes, and procedures are performing. Who are your high-risk, high-cost patients? Which procedures are most effective at early diagnosis and therefore minimize downstream costs? How do you assess which strategic partnerships will support your long-term strategy? How do you even set a long-term strategy in this market?

Many organizations assume their EHR provider can assist with this, but few if any have the tools or experience to provide insight into the patterns and quality of care that are experienced by groups of patients. However, the data currently contained in EHRs, billing systems, and other databases is the foundation upon which this insight can be gleaned. Finding system-agnostic tools to analyze data from different sources— clinical, financial, and operational— will enable your organization to objectively and accurately assess performance, identify opportunities and adjust your strategy with confidence. Once new targets and goals are in place, this same analysis should enable you to monitor performance (clinical and financial) toward those goals to confirm or adjust your strategy. Providers who take this approach will have a much smoother transition to the new realities of our market. Providers who don’t will likely struggle and either fail or become a target for a competitor who did.