The Intersection of Value-Based Care and Advanced Analytics: A Pathway to Better Health Outcomes
What happens when you link reimbursement directly to patient outcomes and overall efficiency? That’s precisely what value-based care (VBC) is all about. To succeed with this model, payors and providers leverage data and the insights they can gain from it.
Advanced analytics can help turn traditionally fragmented data from multiple sources into clearer, more actionable intelligence. Essentially, the right analytics platform has the potential to promote VBC goals of optimizing health and wellness while reducing the total cost of care. Here’s how.
Improving Contract Performance with Data Intelligence
Value-based care attributes healthcare spending to measurable positive health and financial outcomes. Advanced analytics can help bring this idea to fruition by helping health plans and health systems manage and monitor value-based contracts.
By continuously tracking contract measures and member outcomes, analytics solutions help payors to:
- Identify and understand the impact of social determinants of health on routine preventive care and appropriate utilization
- Uncover and address care gaps
- Support course correction for performance in near real-time
This type of proactive performance management makes sure that contract terms aren’t just deliverables on paper — they’re the driving force behind care quality and cost efficiency.
Imagine trying to achieve this level of care with a handful of spreadsheets or with traditional manual reconciliation. It simply isn’t possible at the scale and depth that stakeholders at providers, payors and state agencies require.
Better Decisions Begin with Eliminating Data Silos
One of the biggest hurdles in value-based care, and in healthcare in general, is the fragmentation and abundance of disparate sources of data. Advanced analytics allows payors and providers to consolidate information from diverse sources into a single, secure platform with a broad view as well as granular insight into individual contract performance.
Not only does such an integration reduce the need for manual reconciliation, it also gives payors, providers and state agencies access to the same information, enabling alignment across populations and fostering collaboration and the ability to work together to support VBC goals.
Predicting Outcomes and Supporting Proactive Interventions
The heart of how advanced analytics improves value-based care is rooted in its ability to forecast based on historical and current data from payors, providers, demographics and more. Predictive analytics expose potential challenges and rising risks before they escalate into more complex issues.
This type of predictive analytics helps organizations intervene while safeguarding both financial performance and patient care. For example, advanced analytics can:
- Forecast which patients are at a higher risk for hospital readmission, development of chronic conditions or other adverse health events
- Identify patients who are likely to miss preventative care appointments or screenings, helping pave the way for better outreach and more timely interventions
- Uncover avoidable high-cost service demand, including emergency room visits, hospital admissions or outpatient services to better manage utilization
- Calculate potential cost savings or losses based on near real-time measures performance or intervention outcomes to ensure full reimbursement and avoid penalties
- Predict HEDIS measure performance or identify the factors to adjust risk scores in order to optimize contracts while uncovering areas for continuous improvement
Improving Collaboration and More Unified Decision-Making
When diverse data, sourced from payors and providers, creates holistic member/patient profiles in an advanced analytics platform, both partners benefit from shared access to the resulting actionable insights. Dashboards targeted to stakeholders, from leadership to administrators to care coordinators and practice managers, show opportunities for improvement. Together payors and providers can prioritize actions to improve the delivery of care, optimize resource allocation and boost contract performance.
Behind-the-Scenes: How the Technology Works
Today’s advanced analytics platforms are able to deliver actionable insights with advances in technology including artificial intelligence (AI) and machine learning (ML) changing how efficient and effective value-based care is delivered.
Combine these with integrated cloud-based architecture, and advanced analytics insights are available and accessible from any device. There isn’t a more secure, stable and effective way to identify and address today’s most challenging healthcare demands.
Getting Started with an Advanced Analytics Solution
There’s no turning back the shift to value-based care. Advanced analytics and centralized data platforms are no longer “nice to have” — they’re essential requirements in a value-driven environment. Through powerful features including near real-time monitoring, predictive projections and collaborative data views for decision-making, tools like these help healthcare organizations optimize contract performance, while also improving health outcomes.
Meeting today’s healthcare challenges isn’t just about advances in technology. It’s about reshaping healthcare into a more proactive and patient-centered effort with the right tools and systems leading the way. CoreTechs® Analytics solutions by Gray Matter are finely tuned and aligned with the latest in advanced ML and AI technology, so that analytics not only spot care gaps and avoidable utilization but also provide insights on ways to enhance operations, improve health outcomes and drive cost efficiency.
Learn more about how Gray Matter is leading the way in providing data-driven insights that directly affect patient care and operations effectiveness. Through our powerful, highly configurable platform, we’re helping payors and providers alike optimize value-based care. Gain the insights your organization needs in order to succeed in a value-based care world.
