AUGUST - 201919MOVING TOWARD MORE REAL-TIME AND EFFICIENT VALUE-BASED CARE ANALYTICS Value-based care (VBC) contracts are designed to incentivize providers to manage healthcare costs while maximizing healthcare quality for a specific set of individuals ("members"). VBC is currently an area of active experimentation by healthcare providers and payers. Many VBC models include a mixture of shared savings, global and partial capitation, episode-based payments and bonuses around specific quality and utilization metrics.Effective analytics are essential for success in VBC. The analytics needed include provider performance scorecards, member risk stratification, intervention outcome evaluations, forecasting, quality dashboards and algorithms to improve diagnosis coding accuracy. Payers that create VBC contracts typically supply their provider partners with data and reports based on healthcare claims data, to highlight opportunities and provide performance feedback. The data and reports supplied by payers often have limitations including time lags (latency inherent in healthcare claims data), lack of personal ID numbers that tie across data sources and absence of important clinical details in the data (e.g., lab test results). Providers participating in VBC contracts have the opportunity to make analytics more "real time" by supplementing healthcare claims data with electronic medical records (EMR). EMR data has many strengths. The data has minimal latency (typically, EMR data in analytic warehouses is refreshed daily), EMRs have excellent patient coverage (providers strive to keep accurate EMRs for all patients) and EMR data include a great amount of clinical detail. While parts of the EMR data are unstructured, much of the most useful information in EMR data is structured and relatively easy to use for analytic purposes (e.g., detailed service descriptions and dates, service location, lab test results, patient vitals, providers with various roles in the encounter). EMR data is excellent in forecasting and prediction, early utilization monitoring, physician quality dashboards and identifying high-risk patients, among other analytic purposes. Despite the strengths of EMR data, there are some challenges to incorporating EMR data in VBC analytics. Payers typically supply providers with lists of members participating in a VBC program. However, these member lists often include sparse member information which is subject to change and Doug ThompsonBy Doug Thompson, System Director, Population Health Analytics, Rush HealthCXO Insights
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