“ACA is Here to Stay” – Now What? – DATA!

ACA is Here to Stay
ACA is Here to Stay
The recent Supreme Court ruling should put an end to any uncertainty about the near term future of the Affordable Care Act.  Regardless of each individual’s political leanings, the healthcare industry has been transformed over the past five years and those changes will continue into the foreseeable future.  As an industry, we need to focus on supporting the changes that have started and create a path to a new vision of health security and healthfulness for all system participants.  This path can only be built on a strong platform of comprehensive and accurate data, coupled with sophisticated analytics and a firm commitment to excellence. New data sources will enable us to make good decisions and to monitor the effectiveness of those decisions.

The tenets of the Triple Aim provide a good framework for all segments of the industry.

  • Member Experience
  • Population Health
  • Reduced Cost

Improve the Care Experience:  There are multiple buzzwords floating around – consumerism, engagement, etc. – but the focus needs to be on a better understanding of the patient (or member) and developing more effective ways of educating and incenting each of them to embrace a healthier life style, be compliant with appropriate behaviors for prevention and treatment and effectively participate in the health care system when needed.  The good news here is that there are existing analytic methodologies that have been successfully harnessed by retail and other industries that can lead us to solutions.  Multiple data sources are available that will give us the profile of our members (or patients) with the specificity to understand how to most effectively involve each of them and meet their expectations. Many of these data sources are new and will require new technologies to successfully acquire and profile them so that they can be effectively leveraged. These tools will enable us to provide a more personalized care experience, empower our healthcare workers with actionable data and successfully reach the remaining uninsured eighteen million Americans.  We will also be in a better position to influence the measurement of the healthcare experience as new quality metrics are rolled out by CMS and others.

Population Health:   Harnessing the power of data is especially compelling in the arena of clinical care.  The evolution of “Big Data” provides researchers and physicians with amazing amounts of new information that they will be able to use to develop new treatment options and to personalize those treatments for much improved effectiveness.  Our ability to aggregate data and share it via HIE’s and other networks will provide the point of service information that can significantly improve outcomes.  Leveraging “Big Data” and the IOT (Internet of Things) will provide new and unexplored data sets that will need to be profiled and better understood to support both population health and individual care plans.

Reduce Cost:  This is a topic that has been on the healthcare agenda throughout my career – and I expect yours.  Whether you are a provider, working with an insurance company, or supporting the system in other arenas, we are always challenged to find ways to wring costs out of the system without jeopardizing our other goals.  The current frenzy around mergers and acquisitions is one response to this challenge, and one that is likely to continue.  Renewed focus on operational processes will also continue.  We need to take care not to do “stupid things” rather than use data and process improvement to drive waste from the system. We have an array of tools that will support the effort of bringing data together, identifying patterns and determining benchmarks for our day to day operations as well as clinical care.  These tools are now able to support real time, or near real time, processing to allow us to be far more nimble that we have in the past.