By Mike Boswood
Sparked by a need to reduce costs and fueled by the Affordable Care Act, the healthcare industry is moving to a retail-based, consumer-oriented model.
As a result, individuals are taking on greater responsibility for their care — including choosing which treatment option is best for them, which provider they’d like to use, and how they want to spend their healthcare dollars. This is a challenge for many people who don’t have the information they need to make smart, well-informed healthcare decisions.
It’s also a struggle for health plans. Meeting consumer demands for tools to support decision making is just part of their challenge. In addition, health insurers are undergoing rapid internal change as they shift to an individual business model in response to health insurance exchanges and Medicaid expansion.
In order to effectively manage the care of a growing population, including the newly insured, health insurers need tools that can provide granular detail on individual healthcare experiences, identify patterns of behavior, and quickly spot outliers for intervention.
Advanced analytics can help. But only if the analytics are combined with “good” data and a deep understanding of the healthcare landscape.
By integrating proven analytic methods and industry expertise from Truven Health with IBM’s Enterprise Health Analytics platform, we can help health insurers leverage technology and analytics in new ways to improve the quality and value of care. With this combined solution, health insurers and their associated health systems can bring together structured and unstructured data sources from payers, providers, and consumers to identify gaps in care, handle financial reporting and manage cost requirements. They can also use the insights gleaned to assess program and provider performance, ensure payment integrity, and monitor compliance and prevalence over time.
For example, health insurers will be able to identify patterns of disease management for enrollees with chronic conditions like diabetes, segment those by region, provider, and cost, and then measure any changes over time or even chart changes in the impact of different preventive measures on the conditions. All of these inputs can be used to evaluate quality of care and – ultimately – to drive value-based reimbursement models that will reward providers that deliver the best care at the best price.
In addition, IBM’s Consumer Price Transparency solution, which streamlines the process of shopping for a procedure or facility, will now incorporate healthcare pricing estimates from Truven Health. The retail shopping solution will leverage IBM’s robust commerce platform and Truven’s proven methodologies to calculate real-time, personalized, out-of-pocket costs for a wide variety of medical procedures and treatments, making the promise of data analytics a reality for everyday consumers who can now comparison-shop for the best quality care based on targeted, empirical evidence, not a gut decision.
We are entering into an era where data and technology are aligning to make amazing things happen. Properly used, the most promising analytics will help health insurers respond to today’s rapidly changing healthcare environment and empower people to become educated consumers of healthcare.