A year in review: The growing role of analytics in value-based care

By Milliman MedInsight

18 December 2023

This past year, the industry has witnessed significant advancements in value-based care (VBC) models. As the industry continues to move away from traditional fee-for-service models, there has been a growing emphasis on population health management, the integration of technology and analytics, and the implementation of collaborative care models. These developments have been instrumental in driving the adoption of advanced analytics, which play a pivotal role in the success of Accountable Care Organizations (ACOs).

To gain deeper insights into the role of analytics in the journey towards VBC, we recently had the opportunity to speak with MedInsight’s Vice President of Product Strategy, Francesca Hammerstrom. In our conversation, we explored how analytics can assist ACOs in their pursuit of VBC, enabling them to streamline workflows and achieve success in their VBC initiatives in 2024 and beyond.

Q. ACOs are increasingly relying on advanced analytics to gain insights into their performance and make data-driven decisions. What challenges have you seen this past year that have driven analytics adoption?

A: One significant challenge that is particularly demanding for organizations is limited time and resources to devote to advanced analytics. To address this, ACOs are seeking reliable analytics tools that can support a variety of data users, ranging from information consumers (non-professional analysts) to data scientists.

For example, enabling information consumers to access and utilize data empowers more users within the organization to address their business questions through self-service analytics, reducing their reliance on professional analysts. Guided analytics can free up analysts’ time to focus on data science initiatives. Similarly, data scientists spend a significant amount of time, up to 80% or more, on getting data into a workable format for their work. However, with the help of powerful automation tools, data scientists can unlock the full potential of the data and accelerate the speed at which insights are generated. Because VBC is a team effort, ACOs should carefully consider adopting an analytics engine that not only effectively analyzes data but also presents it in a manner that instills confidence among users. This is crucial as ACOs strive to identify high-risk patients, track patterns of care utilization, and develop targeted interventions to drive positive change in patient care and outcomes.

Q. How are ACOs facilitating the transition towards CMS’ goal of having 100% of traditional Medicare beneficiaries in an accountable care relationship by 2030? Additionally, how will analytics assist in this transition process?

A: The healthcare industry has been engaged in ongoing discussions about the gradual transition to VBC. However, significant changes are expected to occur within the next three years.1 The prevailing economic climate, marked by financial constraints and rising costs, is compelling healthcare systems to take decisive action. This includes optimizing resource utilization and improving the quality of patient care, thereby accelerating the shift towards VBC and need for reliable data insights.

Organizations that are just starting out or experimenting often follow a common trajectory. As they begin their journey, these organizations typically have limited experience and capabilities in analytics, as well as limited risk exposure. However, as they grow in their adoption of risk-based payments, their analytics capabilities also must evolve to support their needs. This growth in analytics capabilities is crucial for organizations to effectively navigate and succeed in VBC. By leveraging advanced analytics, these organizations can gain insights into their performance, make data-driven decisions, and effectively manage the risks associated with VBC payment models. As they continue to mature on their VBC journey, organizations gradually enhance their analytics capabilities, enabling them to better understand and optimize their financial and clinical outcomes.

Q. What impact does MedInsight have in helping ACOs leverage analytics to achieve value-based care success?

A: MedInsight offers a wide range of analytic offerings through its VBC Platform that cater to ACOs at any stage of their VBC journey. Whether you are just starting out with a bundled payments program or seeking more flexible analytics and control over your data, we have products that can meet your needs. For instance, our VBC Contracts solution enables users to forecast their contract performance and compare multiple contracts side by side. We specifically target common areas of interest for most organizations, including post-acute care, ED utilization, site of service, benchmarking, end-of-life and palliative care, and pharmacy medications. Our comprehensive suite of products aims to provide valuable solutions across the VBC spectrum.

In fact, ACOs that have embraced our platform as part of the Medicare Shared Savings Program (MSSP) have achieved an impressive $274M in shared savings in 2022. 80% of MSSP ACOs using MedInsight achieved shared savings, surpassing the national average by nearly 20%. It is truly exciting to witness how our VBC Platform is enabling ACOs to tackle significant challenges by effectively bridging the gap between cost management and care management.

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  1. Health system execs see a value-based care tidal wave ahead (beckershospitalreview.com)
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