By Carol Newcomb, Senior Consultant
Imagine, for a moment, that we have moved on from the ugly, tedious healthcare debate of 2009 and the year is 2014. Pretend that Lieberman has joined the Republican Party and that the 2010 ‘Kennedy Healthcare Reform Bill’ passed with a sweeping majority of both Democrats and Republicans, and healthcare providers and insurers are cooperating to provide decent, affordable, cost-justified healthcare. No death panels for grandma and even people without jobs can see a doctor. Now, what have those healthcare organizations been able to achieve in the last four years with their eye on BI?
The Healthcare Providers
When the bill first passed, healthcare providers received Federal grant money to shore up their internal IT infrastructure. But it wasn’t just for technology; it was expected that CIOs would work with the Medical Directors, Nursing Directors, Lab Directors and Admitting Department to inventory the myriad of ‘systems’ and ‘packages’ that struggle to support daily operations.
They had to talk to Finance, Engineering, Purchasing and Human resource users. They had to reach out to the Physician Contracting Group, specialty physician networks that lease space in the hospital facilities, and even the Community Outreach Office to understand how they were handling transactions, contracting, marketing and recruiting.
They were responsible for taking the time to build a comprehensive logical data model of the entire organization, from Building & Grounds to Legal that every system user could understand and that reflected the operational AND analytical objectives their data was intended to support. Even a comprehensive data dictionary, two years in the making and still a work in progress, is available in 2014. That dictionary has information about source systems, data definitions, transformation logic and business rules for appropriate usage.
Customized dashboards for supervisors, managers and directors are available 24/7 that contain a myriad of types of summaries, from staffing and productivity to patient safety alerts or orthopedic device failure rates. End users can customize their dashboard and drill into multiple levels of detail, depending on their question of the hour.
ER physicians can look up the history of a patient that appears on their doorstep and get a comprehensive longitudinal history with shared data from other regional hospitals, since data can now be shared for patient care purposes. If an ER physician needs to speak with a patient’s regular physicians, that information is available at the touch of a button. The price of treating patients in the ER has dropped 40% due to the availability of data that was never there before, a reduction in unnecessary tests and more appropriate treatments.
The Insurance Companies
Insurance companies have NOT been given any Federal funding, but they HAVE been saddled with the responsibility to revisit their actuarial models and include beneficiaries with chronic diseases and pre-existing conditions. As it turns out, they are not that much more expensive to insure, when the cradle-to-grave concept of preventive services, coordinated care, counseling and therapy are included in an individual’s benefits.Instead of selling to employers and unions, insurance companies are responsible for covering populations in an entire geographic region, which prevents them from cherry-picking on the healthiest beneficiaries. If an insurance company can prove, with sufficient data, that the population they provide coverage for is indeed sicker, costlier and in need of more intensive services, then they need to work with both the State government and local physician networks to ensure that physicians are providing cost-effective care.
As a result, the variability across regions, previously attributed to doctors driving up the ratio of services-to-patient, reflects the true healthcare needs of the population, not the doctor’s income expectations. And insurance companies are held accountable by the Federal government to work hand-in-hand with physician advisors to determine which are the cost-effective treatments versus which are unnecessary. These studies are grounded in broad, population-based studies and are backed up with solid statistics.
Insurers are also expected to help medical and nursing students bear the cost of their education, and will place students in medically underserved parts of the country where skilled labor is scarce, so that students don’t incur massive debt to become medically qualified in their profession. Since insurers have been collecting claims data for decades, they are best equipped to use that data in forecasting the need for services, and underwriting studies to investigate emerging technology and preventive services.
The Professional Network
Finally, the professional network of doctors, nurses, social workers, mental health workers and long-term care providers have started on an ambitious, but not impossible, effort to share patient information. This is possible because the States sanction transfer of data based on security and visibility rules as determined through statewide data governance panels. Since platforms for data storage have been standardized based on the ICD-10 and SNO-Med codification systems, it is expected that all qualified professionals have ready access to relevant patient detail at the point of care. This is still a work in progress, but the goal is to have data that support the provision of services to ensure they are appropriate for the individual, and coordinated with other services.
When, in 2014, I look back on 2009, I hope this year represents the year that healthcare finally emerged from the dark ages. That is my holiday wish for BI in healthcare. Imagine the possibilities……
Carol
Newcomb is a Senior Consultant with Baseline Consulting. She
specializes in developing BI and data governance programs to drive
competitive advantage and fact-based decision making. Carol has
consulted for a variety of health care organizations, including Rush
Health Associates, Kaiser Permanente, OSF Healthcare, the Blue Cross
Blue Shield Association and more. While working at the Joint Commission
and Northwestern Memorial Hospital, she designed and conducted
scientific research projects and contributed to statistical analyses.
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