Mak­ing sense of rapid in­dus­try changes

Modern Healthcare - - LETTER FROM TRUVEN HEALTH -

The health­care talk­ing heads are pre­dict­ing the demise of in­sur­ance com­pa­nies as a re­sult of di­rect con­tract­ing, the con­sol­i­da­tion of hos­pi­tals into five or six gi­ant health sys­tems and other rad­i­cal changes—all stem­ming from the Pa­tient Pro­tec­tion and Ac­count­able Care Act. We’ll see if those mas­sive dis­rup­tions will hap­pen in the fu­ture. But real changes are al­ready tak­ing place in the re­la­tion­ship be­tween hos­pi­tals and em­ploy­ers. I think they are for the bet­ter.

At Tru­ven Health An­a­lyt­ics, the only in­de­pen­dent health­care in­for­ma­tion com­pany serv­ing all ma­jor sec­tors of the in­dus­try, we are ac­tively in­te­grat­ing this com­bined ex­pe­ri­ence, data and knowl­edge to ad­dress the re­al­i­ties of the ACA.

The of­ten-con­tentious re­la­tion­ship be­tween em­ploy­ers and providers is shift­ing to one with com­mon goals for com­mu­nity health. Em­ploy­ers are re­al­iz­ing that qual­ity is not a com­mod­ity. Hospi­tal and health sys­tem ex­ec­u­tives are re­al­iz­ing that they are now sell­ers who must demon­strate their value—not just talk about it. The tra­di­tional an­tag­o­nis­tic re­la­tion­ship fo­cused on cost alone is shift­ing into a col­lab­o­ra­tion to de­fine goals for in­creas­ing value and im­prov­ing pop­u­la­tion health. This new col­lab­o­ra­tion re­quires a com­mon lan­guage, com­mon goals and com­mon data. And it gen­er­ates a com­mon need for new trans­parency and bet­ter met­rics. But the govern­ment has not caught up with these needs.

While the ACA re­quires greater trans­parency, the law fails to ad­dress the in­ad­e­quacy of pub­lic data and met­rics to sup­port ef­fec­tive pub­lic reporting of qual­ity across set­tings, as well as prices. And lit­tle has been done to sep­a­rate the need for provider met­rics that help pa­tients make in­formed de­ci­sions from the need to demon­strate con­sis­tent per­for­mance im­prove­ment. The first is dis­ease- and pro­ce­dure-ori­ented. The sec­ond is crit­i­cal to em­ploy­ers and pay­ers that need ef­fec­tive and re­li­able busi­ness part­ners that can achieve mu­tual goals.

It is time to ad­dress those in­ad­e­qua­cies and im­prove pub­lic data sets to meet evolv­ing pub­lic needs. It is also time to clar­ify what needs to be mea­sured, why and for whom. In the mean­time, the pri­vate sec­tor is be­gin­ning to take ac­tion. The cost of do­ing noth­ing is too high. The busi­ness needs of em­ploy­ers and providers will drive timely de­vel­op­ment of bet­ter met­rics from new, in­te­grated data sets for mon­i­tor­ing and achiev­ing mu­tual busi­ness goals.

Jean Chenoweth is se­nior vice pres­i­dent of per­for­mance im­prove­ment at Tru­ven Health An­a­lyt­ics.

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