Poised for Breakthrough: Integrating Claims Data and EHR Data
Up until now, the integration of claims data and EHR data has been an often sought, but seldom realized goal in the healthcare analytics world. It’s a business intelligence idea with so much potential benefit, and it seems like it just wouldn’t be that hard to do. In reality, unifying these two types of data … Poised for Breakthrough: Integrating Claims Data and EHR Data
Using Data in AICU/IOCP Models
The Patient-Centered Medical Home (PCMH) model emerged in response to the recognized need for more systematic and evidence-based approaches to ensuring access to, and coordinating care for, an entire population. Within that framework an additional focus has developed that recognizes the specific needs of members with chronic and complex conditions. In order to respond to … Using Data in AICU/IOCP Models
Observation Status – A Practical Approach to Evaluating Utilization
Over the last few years one day hospital stays have been a focal point for medical management efforts to convert these to observation stays. In addition the 2014 Medicare’s Inpatient Prospective Payment System’s final rule on inpatient admission defines an “appropriate” inpatient admission as one that in the judgment of the admitting physician requires a … Observation Status – A Practical Approach to Evaluating Utilization
Analyzing Healthcare Efficiency Using MedInsight’s Waste Calculator
Rationale for Developing the Initial 20 Measures The concepts for the measures for the newest MedInsight product, the Health Waste Calculator, were identified from various publications about avoidable healthcare, medical waste, and Choosing Wisely. The team identified an initial list of 134 measures to develop. The prioritization of the initial 20 waste calculator measures, version … Analyzing Healthcare Efficiency Using MedInsight’s Waste Calculator
Risk Adjustment for Pediatric Populations
The use of risk adjustment in provider reimbursement arrangements has increased as alternative payment arrangements are becoming more widespread in health insurance. Risk adjustment has been used by Medicare Advantage and managed Medicaid plans to reimburse health plans for the unique risks and populations in their care. More recently, as carriers have transferred utilization risk … Risk Adjustment for Pediatric Populations
Managing Data Supplier Relationships to Ensure Quality
Data quality is the foundation of any data warehouse. As the old saying goes “garbage in – garbage out.” If there are inconsistencies or irregularities in the data loaded into a data warehouse, all analyses based on those data are potentially flawed. Healthcare data are complex, and even data from organizations well experienced in claims … Managing Data Supplier Relationships to Ensure Quality
PHI and APCDs
As more and more states create APCDs, their uses are expanding and evolving. Data generated by APCDs are being used to generate disease, injury, chronic condition, and utilization rates across demographic and geographic settings, as well as by payer type. States are also contemplating linking administrative claims data with clinical data in order to better … PHI and APCDs
Identifying Appropriate Metrics For Population Management
For many reasons, including the advent of the Affordable Care Act, Population Health Management is gaining increased attention from healthcare organizations. A population health initiative has the promise to make care proactive, better coordinated and more customized for the population. A previous blog posting – Analytics for Population Health Management – outlined how populations are … Identifying Appropriate Metrics For Population Management
What Data Is Needed To Support Population Health Management?
In our series of blog postings on the topic of Population Health Management, we have discussed how to define populations in Analytics for Population Health Management, and we have looked at the types of analytic tools available for analysis of populations in
Eliminating Waste in the Healthcare System
Healthcare spending in the United States far exceeds that in other developed countries and the American health care system is widely recognized as wasteful. The Congressional Budget Office has concluded that up to 30 percent of the healthcare in the U.S. is unnecessary. Such estimates of waste are generally based on aggregate data such as … Eliminating Waste in the Healthcare System
Medicaid Population Management
In previous blogs, we’ve discussed Population Management concepts and given specific examples of pediatrics, ACO, and clinical populations. In this blog we turn to the Medicaid population. Medicaid has unique characteristics because of the nature of the financing and because of the social demographics of the population served. This population is going through big changes … Medicaid Population Management
Admissions from the ED
The New York Times recently reported on allegations that a hospital chain was unnecessarily admitting patients from the emergency department (ED) to increase revenues from Medicare and Medicaid[1]. According to the article, one hospital was accused of maintaining a scorecard to keep track of physicians who did not meet a target of admitting at least … Admissions from the ED
Ambulatory Care – Measuring Quality and the Impact of Nursing
The shift of medical care from the inpatient to outpatient setting coupled with the emphasis on transformative designed patient-centered medical home models provides measurement challenges and opportunities. The challenges are how to effectively measure quality in this setting given the range of services that are provided—from routine preventive care to complex surgical and invasive procedures. … Ambulatory Care – Measuring Quality and the Impact of Nursing
Episodes of Care – Appendicitis
Evaluating the relationship between episode of care and length of stay in Appendicitis: In previous posts we have discussed some of the ways episodes of care can be used to compare two different networks and underlying practice patterns. We’d like to dive further on this thread and look at how episodes of care can be … Episodes of Care – Appendicitis
Tips for Ensuring Quality Encounter Data Submission in Medicaid Managed Care Programs
One area of data management within the healthcare industry that is getting new emphasis and interest from regulators is a focus on encounter data. Today, the majority of Americans receiving healthcare services funded through the Medicaid program are enrolled in some form of managed care. Under this scheme, states contract with MCOs that take on … Tips for Ensuring Quality Encounter Data Submission in Medicaid Managed Care Programs
Regional Variation in Utilization – Syncope
Area differences in healthcare utilization have been documented since an area variation analysis of tonsillectomy rates was published back in 1938. Besides the research literature, geographic variation in U.S. healthcare also has been documented extensively for the Medicare population in the Dartmouth Atlas. The Institute of Medicine also released a series of reports on geographic … Regional Variation in Utilization – Syncope
Too Many Spinal Surgeries?
Hospitals have historically relied on surgeries contributing to their top service lines and providing a significant source of revenue generation for hospitals and surgeons. This has, in part, led to the overutilization of surgeries. In the area of spinal surgeries, as noted in the Modern Healthcare article from March 24, 2014, the mounting research evidence … Too Many Spinal Surgeries?
Do Not Overlook the Value of Claims Auditing
This article was originally published in Employee Benefit News. It was written by both David Cusick and Brian Anderson. When seeking ways to keep expenses under control, health care plan sponsors may overlook the value of claims auditing. Auditing fees may not be inconsequential, but the fact is that an accurate audit including both pharmacy … Do Not Overlook the Value of Claims Auditing
Site of Service Savings Opportunities
Most people working in healthcare know that the cost for the same service can vary significantly by setting (e.g. office based vs hospital) and by provider within a setting. The example below illustrates this for a simple surgery with the price doubling in the Ambulatory Surgery Center (ASC) setting and being almost 5 times as … Site of Service Savings Opportunities
Utilization Health Waste in the US Healthcare Marketplace
The American Healthcare system is experiencing rapid change, largely driven by the recognition by both public and private payers that the trajectory of healthcare spending growth must be slowed. Despite the recent slowdown in healthcare spending growth, which many attribute to the recession, efforts to transform benefit design and payment systems are proceeding rapidly. For … Utilization Health Waste in the US Healthcare Marketplace
Health Data Analytics for Identifying Wasteful Services
Eliminating inefficient and unnecessary medical services improves overall healthcare efficiency while reducing costs. In 2009, the Institute of Medicine (IOM) identified $750 billion of wasted spending, with unnecessary services accounting for $210 billion. The Congressional Budget Office has estimated that 30% of medical care in the U.S. is unnecessary care. (Source: Institute of Medicine article … Health Data Analytics for Identifying Wasteful Services
Health Insurance Growth in India
The health insurance industry in India has come leaps and bounds since the launch of the first Mediclaim policy was enacted in 1986. It is the fastest growing segment of the Indian insurance industry, as evidenced by the fact that it makes up 30.5% of the non-life insurance segment of the Compound Annual Growth Rate … Health Insurance Growth in India
Analytics to Achieve the Triple Aim
In 2008, Dr. Don Berwick of the Institute for Healthcare Improvement authored a paper in Health Affairs that introduced the concept of the ‘Triple Aim’1. The Triple Aim is a simple approach to improving healthcare: improving health and experience while reducing the per capita cost. The Institute for Healthcare Improvement created the graphic in Figure 1 … Analytics to Achieve the Triple Aim
Top Five Analytic Trends
It goes without question that the U.S. health insurance industry is in a state of flux. Americans are buying individual products through health insurance marketplaces, new insurance carriers have entered the market, and Medicaid has been expanded in 29 states and the District of Columbia. These market changes, in addition to other reform provisions already … Top Five Analytic Trends
Supporting Patient-Centered Medical Homes through Healthcare Analytics
Although the concept of Patient-Centered Medical Homes (PCMH) has been around for more than 50 years 1, the last decade has seen a revitalization of the PCMH model and an increase in its presence across the nation. The model’s popularity hinges on an approach to providing comprehensive primary care and redesigning healthcare delivery processes. This is … Supporting Patient-Centered Medical Homes through Healthcare Analytics
Potential Overuse of Coronary Angiography Amongst Asymptomatic Population
Coronary angiography is a key diagnostic tool in the management of patients with coronary artery disease. Coronary angiography is used to identify narrowing in coronary arteries and is used for decision support to ascertain the need for revascularization to minimize the risk of myocardial infarction. Various research studies have evaluated trends in the use and … Potential Overuse of Coronary Angiography Amongst Asymptomatic Population
Covered California: Leveraging Telemedicine for Network and Quality Management
Healthcare purchasers, including state-based marketplaces, are making a push to move healthcare payments from volume to value and to transform the delivery system to promote quality of care. Covered California is seeking to do this through its contracting health plans and the qualified health plan (QHP) solicitation process. The most recent solicitation lays out key … Covered California: Leveraging Telemedicine for Network and Quality Management
MedInsight Chosen to Identify Unnecessary Costs and Procedures in Healthcare Delivery
Practical Analytic Approaches to Healthcare Challenges Milliman announced today that its healthcare tool, the MedInsight® Health Waste Calculator, has been chosen by two state All Payer Claims Databases (APCDs) and a leading Regional Health Improvement Collaborative to aid in their identification of unnecessary costs and procedures in healthcare delivery. The Virginia Center for Health Innovation … MedInsight Chosen to Identify Unnecessary Costs and Procedures in Healthcare Delivery
Methodology for Identifying Inpatient Admission Events
Practical Analytic Approaches to Healthcare Challenges Evidence-based measures (EBMs) and many other health insurance data analytics require counts of inpatient admission events and associated costs. There are multiple ways to identify and count inpatient admission events, each of which may produce a different result. As per the California Department of Health Services, the methodologies used … Methodology for Identifying Inpatient Admission Events
What a Pain: Wasteful Low Back Pain Treatments Are Identified
Practical Analytic Approaches to Healthcare Challenges Low back pain is a common problem: more than one in four adults surveyed report having had low back pain during the past three months. Though most low back pain resolves on its own, without medical intervention, it remains one of the most common reasons for physician visits. Imaging … What a Pain: Wasteful Low Back Pain Treatments Are Identified
Task Force on Low Value Care: Fall Convening
Practical Analytic Approaches to Healthcare Challenges The excitement in the room was palpable as 28 attendees descended on the Westin’s Earhart Room in Detroit, Michigan. Stakeholders from across the nation gathered on September 13 with a common goal—to reduce wasteful healthcare services in the United States. Our charge for the day was to prioritize 29 … Task Force on Low Value Care: Fall Convening
Is Risk Adjustment Enough in Population Analytics?
Practical Analytic Approaches to Healthcare Challenges Most analysts conducting population health data analysis understand that no two populations are completely the same. Even within a population with similar attributes – people with congestive heart failure, for example – there will be variances in the population subgroups. Many factors contribute to these variances, including age and … Is Risk Adjustment Enough in Population Analytics?
Pre-operative Laboratory Testing for Low Risk Surgeries
Practical Analytic Approaches to Healthcare Challenges Routinely performing pre-operative testing is a common practice prior to surgery. The American Society of Anesthesiologists (ASA) Task Force defines routine tests as those done in the absence of any specific clinical indication or purpose (i.e. tests intended to discover a disease or disorder in an asymptomatic patient).1 Routine … Pre-operative Laboratory Testing for Low Risk Surgeries
Wasteful Pre-Operative Cardiac Testing Prior to Low-Risk Surgery
Practical Analytic Approaches to Healthcare Challenges Anesthesiologists perform pre-operative assessment on all patients undergoing surgery in order to identify any disease or risks to the surgery and to plan perioperative anesthetic care to mitigate surgical risk. In patients with known cardiac disease, diagnostic cardiac tests such as stress tests and echocardiograms are sometimes recommended as … Wasteful Pre-Operative Cardiac Testing Prior to Low-Risk Surgery
Reducing Healthcare Waste: A Three Pronged Approach
Practical Analytic Approaches to Healthcare Challenges Experts and stakeholders across the industry agree that there is an immediate need to reduce wasteful healthcare spending in the US. A 2012 Institute of Medicine report estimated that one third of US healthcare spending, or $750 billion is wasted annually (Washington Post, September 2012). Of that amount, $210 … Reducing Healthcare Waste: A Three Pronged Approach
Overused Ophthalmology Imaging: More May Not Be Better
Practical Analytic Approaches to Healthcare Challenges Globally, policy makers and payers are focusing on services that are regarded medically unnecessary and do not yield useful results. In the United States, these are referred to as low- or no-value services and are considered wasteful. A significant percentage of the services considered wasteful are medical imaging when … Overused Ophthalmology Imaging: More May Not Be Better
MedInsight Health Waste Calculator Featured in Health Affairs’ Third Most-Read Article of 2017
Practical Analytic Approaches to Healthcare Challenges Milliman’s MedInsight Health Waste Calculator – a leading analytic platform that provides actionable data around healthcare quality, efficiency, and effectiveness – was featured in Health Affairs’ third most-read article of 2017! The article, “Low-Cost, High-Volume Health Services Contribute The Most To Unnecessary Health Spending,” highlights the Commonwealth of Virginia’s … MedInsight Health Waste Calculator Featured in Health Affairs’ Third Most-Read Article of 2017
Clinical Economics of Asthma Controller Medication: Adherence & Outcomes
Practical Analytic Approaches to Healthcare Challenges Asthma is a lifelong disease. In addition to limiting a person’s quality of life, medically it is also associated with significant healthcare utilization and costs.[i] According to a survey in 2015, there were 5.9 million physician office visits and 2.0 million Emergency Department visits in the US because of … Clinical Economics of Asthma Controller Medication: Adherence & Outcomes
Pharmacy Prescription: Is It Generic Enough?
Practical Analytic Approaches to Healthcare Challenges Prescription drugs comprise the third-largest component of U.S. national health expenditures, behind only hospital care and physician services, according to the Centers for Medicare and Medicaid Services.[i] According to the QuintilesIMS Institute, invoiced sales of prescription drugs amounted to $450 billion in 2016, representing 13.4 percent of all U.S. … Pharmacy Prescription: Is It Generic Enough?
Society of Actuaries Podcast: Machine Learning Tools Overview
Practical Analytic Approaches to Healthcare Challenges Machine learning is a hot topic in healthcare analytics today. Shea Parkes and Anders Larson, two of Milliman’s machine learning experts, started a podcast focusing on the subject for the Society of Actuaries (SOA) in 2015. The latest episode was posted May 1, 2018 and is called “Machine Learning … Society of Actuaries Podcast: Machine Learning Tools Overview
Study Results on Asthma Medication Adherence
Practical Analytic Approaches to Healthcare Challenges Asthma accounted for 3,651 deaths, 2 million emergency department (ED) visits, and about 11 million physician office visits for 2014 in United States (US).[i] The estimated total cost of asthma, including medical expenses, loss of productivity resulting from missed work days, and premature death, was $56 billion in 2007.[ii] … Study Results on Asthma Medication Adherence
Healthcare Waste: A Conversation with Dr. Mark Fendrick
Practical Analytic Approaches to Healthcare Challenges Dr. Mark Fendrick conceptualized and coined the term Value-Based Insurance Design and is the director of the Value-Based Insurance Design Center (VBID) at the University of Michigan. His research focuses on how clinical payment and consumer engagement initiatives impact access to care, quality of care, and healthcare costs. He … Healthcare Waste: A Conversation with Dr. Mark Fendrick
Study Results on Claims Data: Can It Be Used To Understand Opioid Prescription Trends?
Practical Analytic Approaches to Healthcare Challenges Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (i.e. opioid pain relievers and heroin).1 In fact, almost 40% of all opioid overdose deaths involved a prescription opioid.2 In addition to the loss of … Study Results on Claims Data: Can It Be Used To Understand Opioid Prescription Trends?
Study Results on Anesthesia in Screening Colonoscopy
Practical Analytic Approaches to Healthcare Challenges The U.S. Preventive Services Task Force recommends colorectal cancer screening for men and women aged 50–75.[i] For colorectal cancer (CRC) screening, colonoscopy has been accepted as the most effective method, with the adenoma detection rate (ADR) remaining one of the most important measures of a quality colonoscopy. Factors shown … Study Results on Anesthesia in Screening Colonoscopy
Study Results on the Effectiveness of Annual Physicals
Practical Analytic Approaches to Healthcare Challenges There has been an ongoing debate in United States (US) on the value of the annual comprehensive physical examination. One school of thought recommends elimination of the annual comprehensive physical exam due to lack of value. Choosing Wisely 2014 states that healthy people often do not need annual comprehensive … Study Results on the Effectiveness of Annual Physicals
Harvard Medical School, VBID Health & MedInsight Twitter Chat on Healthcare Waste
Practical Analytic Approaches to Healthcare Challenges Last week on Twitter, we hosted a Twitter chat with Milliman about healthcare waste in the industry. Are you ready to discuss ways that the U.S. #healthcare industry can curb unnecessary spending? Tune into the #healthwaste chat today. pic.twitter.com/VJoa9nbukq — Milliman, Inc. (@millimanhealth) August 2, 2018 MedInsight’s Rich Moyer and … Harvard Medical School, VBID Health & MedInsight Twitter Chat on Healthcare Waste
Beta-Blocker Therapy Study: Why Adherence Matters
Practical Analytic Approaches to Healthcare Challenges Heart failure (HF) is a global pandemic affecting at least 26 million people worldwide that is increasing in prevalence. Currently about 6 million people in the United States (US) have heart failure, and prevalence is projected to increase to more than 8 million people by 2030 [i],[ii] Direct medical … Beta-Blocker Therapy Study: Why Adherence Matters
New Proposed ACO Rule Change: Pathways to Success
Practical Analytic Approaches to Healthcare Challenges On August 8, 2018, the Centers for Medicare and Medicaid Services (CMS) released a sweeping proposed regulation that, if enacted, will significantly change the Medicare Shared Savings Program (MSSP). The proposed regulation, titled “Pathways to Success,” accelerates the path for accountable care organizations (ACOs) to participate in shared risk … New Proposed ACO Rule Change: Pathways to Success
ACO Proposed Rule Change: A Choice Between Two Tracks
Practical Analytic Approaches to Healthcare Challenges The Centers for Medicare and Medicaid Services (CMS) proposed a new rule in August of 2018 to change the structure of the Medicare Shared Savings Program (MSSP). This will affect current and future ACOs whether they participate in a track with one-sided or two-sided risk. Currently, three MSSP tracks … ACO Proposed Rule Change: A Choice Between Two Tracks
ACO Proposed Rule Change: Non-Track Changes
Practical Analytic Approaches to Healthcare Challenges On August 9th, 2018, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule change to the current Medicare Shared Savings Program (MSSP) structure. Along with updates to the tracks that are available to Accountable Care Organizations (ACOs) through the program, a number of new features and … ACO Proposed Rule Change: Non-Track Changes
ACO Rule Change: Impact of Proposed Rule on Track 1 and New MSSP ACOs/The BASIC Track
Practical Analytic Approaches to Healthcare Challenges The new rule proposed by the Centers for Medicare & Medicaid Services (CMS) on August 9, 2018 would result in significant changes to the way the Medicare Shared Savings Program (MSSP) works for new Accountable Care Organizations (ACOs) and those currently in a one-sided risk model. Under the current … ACO Rule Change: Impact of Proposed Rule on Track 1 and New MSSP ACOs/The BASIC Track
How ACOs Can Build Confidence in Their Data
Practical Analytic Approaches to Healthcare Challenges All healthcare data has data quality challenges. However, as Accountable Care Organizations (ACOs) have taken on more risk and are working on improving care processes data quality has become a more important issue. Below are some common data quality issues that ACOs face and some of the solutions ACOs … How ACOs Can Build Confidence in Their Data
Communicating with Patients with Hearing Loss
Practical Analytic Approaches to Healthcare Challenges Poor compliance with healthcare provider advice for health and wellness actions is a growing issue. For older patients, hearing loss may contribute to lack of adherence with provider guidance. BACKGROUND The U.S. Census Bureau projects that by 2035, there will be 78 million people who are age 65 and … Communicating with Patients with Hearing Loss
The Value in Retrospective Data & Reporting in Provider Analytics
Practical Analytic Approaches to Healthcare Challenges Technology continues to advance almost daily and data sources and real-time data access are rapidly expanding in healthcare. These advances, combined with the shift from fee-for-service to value based reimbursement, mean healthcare analytics and reporting are changing too, and access to timely data is critical. But do all these … The Value in Retrospective Data & Reporting in Provider Analytics
CMS Pathways to Success: Highlights of Final Rule Changes
Practical Analytic Approaches to Healthcare Challenges On December 31st, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule change to the current Medicare Shared Savings Program (MSSP) structure called “Pathways to Success”. While this rule looks to accomplish additional goals, the main focus is to transition Accountable Care Organizations (ACOs) into … CMS Pathways to Success: Highlights of Final Rule Changes
Antidepressant Monotherapy in Bipolar Disorder: Prescription Patterns
Practical Analytic Approaches to Healthcare Challenges Mental disorders are considered among the leading causes of ill health and disability worldwide. The United States spends an estimated $201 billion on mental disorders, making it the most costly medical condition in the country.1 Bipolar disorder is a common mental health condition, and the US has the highest … Antidepressant Monotherapy in Bipolar Disorder: Prescription Patterns
Drug Cost Trends 2015 to 2017 & The Top 20 Drugs
Practical Analytic Approaches to Healthcare Challenges The Centers for Medicare and Medicaid Services (CMS) identifies prescription drugs as one of the major components of U.S. national health expenditures, after hospital care and physician services.1 The US Assistant Secretary for Planning and Evaluation (ASPE ; principal advisor to the Secretary of the U.S. Department of Health … Drug Cost Trends 2015 to 2017 & The Top 20 Drugs
Diagnosis Related Group-Based Readmission Profiling
Practical Analytic Approaches to Healthcare Challenges Introduction High rates of unplanned readmissions indicate poor quality of care or gaps in care coordination, and bring an increased financial burden on the healthcare system.[i] The major reasons for unplanned readmissions include premature discharge from initial hospitalization, gaps in post-operative care, unnecessary inpatient admissions from the Emergency Department, … Diagnosis Related Group-Based Readmission Profiling
Top 7 Critical Point Podcasts by Milliman
Practical Analytic Approaches to Healthcare Challenges Critical Point is a podcast by Milliman, hosted by subject matter experts including actuaries, clinicians, technology specialists, and economists. These seven episodes take a deep dive into subject matters that affect the health and well-being of people across the world. Critical Point examines the inherent challenges and innovative solutions … Top 7 Critical Point Podcasts by Milliman
Over Half of Emergency CT Scans of the Head for Dizziness Are Considered Wasteful
Practical Analytic Approaches to Healthcare Challenges Dizziness accounts for 3.3% of all Emergency Department (ED) visits annually. This corresponds to about 2.6 million ED visits per year in the United States.¹ A Computed Tomography (CT) scan of the head is one of the most frequently used diagnostic procedures for evaluation of dizziness in the ED, … Over Half of Emergency CT Scans of the Head for Dizziness Are Considered Wasteful
Telehealth Data Analytics: Adoption Trends & Value
Practical Analytic Approaches to Healthcare Challenges Telehealth is the use of electronic information and telecommunication technologies to support remote clinical healthcare, patient and professional health-related education, public health, and health administration. Currently millions of Americans are residing in areas with a shortage of primary healthcare providers and often experience delays to see a provider.[i] Telehealth … Telehealth Data Analytics: Adoption Trends & Value
The increasing relevance of risk scores on MSSP ACOs
Practical Analytic Approaches to Healthcare Challenges Medicare Advantage plans have long recognized the importance of coding to ensure accurate risk scores and clinical documentation. By contrast, Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) often focus less on the implications of risk adjustment or assume they have little ability to affect … The increasing relevance of risk scores on MSSP ACOs
Doing Predictive Analytics with Python: Podcast Series
Practical Analytic Approaches to Healthcare Challenges Python is a very popular coding language for doing predictive modeling and data science. We have been discussing python as part of our ongoing Predictive Analytics podcast series for the Society of Actuaries. Four episodes are available for listening now: Episode 1: This is the first of a few podcasts … Doing Predictive Analytics with Python: Podcast Series
Data Confidence for ACOs
Incomplete Provider Data Provider level analysis is extremely important for ACOs. ACOs need to know which providers both within and outside the ACO network are providing services to patients attributed to the ACO. This is important not only to work towards bringing a larger percentage of services in-network (leakage management), but also for quality and … Data Confidence for ACOs
Chronic Condition Analysis: Selecting a Diagnostic Grouper
With over 77,000 codes, ICD10 diagnosis codes provide a much needed level of granularity for clinicians to use in caring for patients, but they are not particularly useful for large scale analytics. As a result, analysts have developed many different diagnostic groupers to group ICD10 codes into meaningful categories for analysis. Several are available within … Chronic Condition Analysis: Selecting a Diagnostic Grouper
Reporting Framework for Value Based Care
As the cost of healthcare continues to rise, both payers and providers continue the “triple aim” of delivering effective quality care while managing their costs. Value based care (VBC), or value based reimbursements, has emerged as an effective mechanism for achieving this goal. In fact, based on estimates developed by National Business Group on Health, … Reporting Framework for Value Based Care
Why adherence matters in diabetes
Medication adherence is important for pharmaceutical therapy to be effective in patients with chronic diseases, including diabetes. Medication adherence in diabetics is associated with lower risk for hospitalizations, lower healthcare costs, and lower mortality. Various publications have reported positive correlations for patient demographics, such as older age, male sex, higher education level, and higher income, … Why adherence matters in diabetes
New MedInsight ebook: Gain a competitive edge with next-level employer group reporting
Advanced Employer Group Insights demonstrate the value of your health plan As healthcare costs rise, health plans need tools that enable them to demonstrate the value of their plans and provide data-backed answers to the questions that keep business owners up at night. How MedInsight Employer Group Insights (EGI) can help Backed by decades of … New MedInsight ebook: Gain a competitive edge with next-level employer group reporting
How the pandemic sparked a digital transformation in healthcare data analytics
The COVID-19 pandemic revolutionized the way healthcare organizations transform data into timely information, reporting and decision-making. When the pandemic first hit, the general approach to healthcare data analytics was lacking: critical data could not be accessed in real-time nor made available to other healthcare providers, policymakers and the public. For example, ICU bed utilization was … How the pandemic sparked a digital transformation in healthcare data analytics
An ocean of data & a desert of insight: transforming healthcare payer data into strategic insights
From claims to EMRs to lab and third-party data, healthcare payers have more data than ever at their fingertips – over 2.3 zettabytes per year according to a Statista projection. And healthcare data continues to grow. The value of data-driven insights for payers is undeniable. Yet, many payers struggle with transforming mounting data into data-driven … An ocean of data & a desert of insight: transforming healthcare payer data into strategic insights
The right data for every model of value-based care contracting
How MedInsight Supports Organizations on the Glide Path to Risk For healthcare provider organizations navigating the array of alternative payment models in use across all phases of value-based care contracting, the complexity can be daunting. From small physician groups operating on a largely fee-for-service basis to health plans managing the claims of tens of thousands … The right data for every model of value-based care contracting
How to minimize total cost of care with healthcare data analytics
When it comes value based-care accounting, few metrics are as useful as Total Cost of Care (TCOC). TCOC can show you precisely where your value-based care initiatives should be focused for the most efficient use of resources. And yet, as useful as TCOC can be, there are few metrics as difficult to pin down with … How to minimize total cost of care with healthcare data analytics