Despite some recent potential setbacks, most healthcare experts agree that the U.S. will continue down the path of changing reimbursement from the traditional fee-for-service model to one that emphasizes value-based care.

Healthcare today accounts for one out of every six dollars spent in the U.S., a staggering figure. Worse, that amount is still expected to rise to one out of every five dollars spent by 2025. Most alarming, however, is most of the money spent today isn’t tied to any particular outcomes or benefits – it is still based on activities alone.

The realization has dawned on the industry that this approach is not only unsustainable but unacceptable. In other words, transitioning to value-based care is the right thing to do.

Of course, it doesn’t hurt that patients/members themselves are now feeling the pain of paying for healthcare more directly. High-deductible health plans result in patients/members making sizeable payments they can see. Since they can no longer live by the mantra “the insurance company will cover it” they have become much more aware of the cost of care—and and what results are being generated as a result.

The inevitable conclusion is the demand for value-based care is there, and will increase over the next decade regardless of whether or not it is mandated by the government. The only question is:  How do healthcare organizations make the transition as painlessly as possible?

Next-generation predictive analytics can help healthcare organizations use the information they’ve gathered about the past to predict what will happen in the future, and to demonstrate the likely outcomes for each of several future options. By supplementing clinical, operational, and claims data with socioeconomic, psychographic, and other types of outside data, healthcare organizations can gain a 360-degree view of the issues and draw even more precise conclusions.

Here are some of the ways next-generation analytics can help guide healthcare organizations down the path toward value-based care.

Improve your ability to manage population and financial risk

This is one of the most common ways analytics are being used to facilitate the transition to value-based care. Healthcare organizations are very familiar with the need to predict and manage risk. Yet in the past, this has mostly consisted of identifying the worst-case scenarios rather than looking for opportunities.

Two key areas where next-generation analytics can help are with assigning risk scores around the impactability and intervenability of patients. Impactability involves not just identifying which patients have care gaps (which most population health management tools can do) but then stratifying the impact closing those care gaps will have on outcomes. It also shows which care gaps should be prioritized for the greatest impact.

Intervenability assigns a risk score based on how willing and able the patient/member is to participate and engage in his/her own care. With a 360-degree data view, healthcare organizations can not only see which patients/members historically have been more engaged but also gain insights into why some have poor track records. The analytics help determine whether it’s a matter of unwillingness (which is difficult to overcome) or an inability due to certain circumstances. Two examples are a patient/member in a low-income area who can’t afford name-brand prescription medications, or one who can’t have medications for chronic illness delivered to his/her home in bulk due to the size of the mailboxes in the building.

Uncovering patients/members who will generate the best clinical and financial outcomes if the right resources are applied will help healthcare organization leaders set priorities based on data.

Ensure you are complying with quality measures

Since delivering positive outcomes is a key component of value-based care, it is important to be able to measure the quality of care being delivered across the organization. Next-generation analytics simplify this process to help healthcare organizations understand where the opportunities to improve patient/member outcomes exist.

 For example, organizations can use the analytics to segment and prioritize the patients/members who have the greatest risk of negative outcomes. They can then narrow the focus to those for whom closing care gaps will deliver the greatest health and financial outcomes.

By keeping their limited resources concentrated on patients with the greatest impactability, healthcare organizations can ensure they see the greatest returns on their value-based care investments.

One area where this plays well in the current environment is with chronic conditions. Healthcare organizations can use analytics to deliver insights how to take a proactive approach to managing these conditions based on current success rates, and look across provider performance to drive quality measure compliance even higher.

Ensure network performance is optimized

Determining the risks around various populations is essential to understanding what the costs, utilization, and resource demands for those populations are likely to be in the future. This is what will help healthcare organizations manage those resources more effectively.

Analytics can help uncover this information, as well as pinpoint where care is being delivered and if it is being delivered efficiently. They can also uncover where and why leakage is occurring, helping healthcare organizations reduce associated costs through patient/member and provider outreach. Finally, analytics can help these organizations develop strategies to expand their networks where appropriate.

Smoothing the path ahead

As we have already seen, the road to value-based care can be a rocky one. Yet it is a journey worth taking.

Next-generation analytics can help smooth the way, reducing risk at each step to reach the goal we all want – a high-quality, affordable healthcare system that makes sense.

About Rose Higgins

Rose Higgins is president of SCIO Health Analytics. Prior to joining SCIO Healthcare Analytics, Higgins was the senior vice president and general manager for population and risk Management at McKesson

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