Analytics. Big data. The year is 2018 and the advantages of the effective use of data analytics have become apparent to practically all business models, including healthcare. While previous efforts have been launched mostly independently within the different sectors, recent initiatives demonstrate the value of sharing data among payers, regulators, and providers to improve value-based care. Integrated healthcare systems can be used to deliver valuable analytics to the different parties involved in care delivery or can be developed to improve the quality of healthcare services within an organization.
Learn how new operations to disperse data analytics regarding claims, healthcare spending trends, and other clinical information can be used to improve population health and reduce unnecessary healthcare spending.
How Can Wasteful Healthcare Spending be Reduced?
All-Payer Claims Databases (APCDs), deliver valuable insights into healthcare spending by allowing payers, regulators, and providers the ability to view millions of claims at a glance. Analyzing this data provides the information needed to determine where the majority of healthcare spending occurs and if excessive spending on specific healthcare services can be avoided.
Sixteen states have established payer claims databases at the state level. According to a recent article in Health Payer Intelligence, many other states are considering the development of regional operations that will provide information on provider charges, diagnoses, payments, and patient demographics to the public. Progress made by the states that currently use APCDs shows that wasteful healthcare spending can be reduced by effective population health management, and taking care of opportunities to decrease spending within the public and commercial sector.
A recent report by the American Health Policy Institute (AHPI) (download the .pdf), estimated that up to $2 billion in annual employer spending is “wasteful”. Therefore, they concluded that commercial payers and employers which provide insurance coverage have the greatest opportunity to use APCD information to decrease spending. As stated in the AHPI report:
“This study concludes that over $2 billion of employer healthcare spending is wasteful and unnecessary, out of total spending of approximately $10 billion. One objective of this effort is to draw a distinction between high value and low value healthcare services in order to reduce or eliminate wasteful spending. Another goal is to reduce inefficiencies in healthcare delivery and financing, thereby producing greater value. Studies indicate that reductions in wasteful spending resulting in lower costs can also lead to higher quality care. “
Integrated Healthcare Systems Can be Used to Improve Population Health
As reported in another article from Health Payer Intelligence, North Carolina has payers collaborating with the data-driven population health leader, Community Care of North Carolina (CCNC) to improve population health. The collaboration aims to develop integrated healthcare systems that can help address the concerns plaguing vulnerable Medicaid beneficiaries through the identification of the at-risk patient populations and appropriate action planning and implementation.
In January 2018, Aetna made the announcement about their partnership with CCNC to improve integrated health systems to the population of North Carolina. Laurie Brubaker, president and CEO of Aetna Medicaid was quoted in the press release stating:
“We look forward to working with CCPN, CCNC and CPESN to develop an integrated health care delivery system that builds on existing care management programs, provides a holistic approach to health and expands the provider/payer collaborative to improve health for the Medicaid and North Carolina Health Choice populations.”
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