Un­der­stand­ing Value at the Cross­roads of Costs and Out­comes

Tra­di­tion­ally, clin­i­cal data has been siloed from fi­nan­cial and op­er­a­tions data, viewed with dis­tinct im­pli­ca­tions. Anita Ma­hon of IBM Wat­son Health, ex­plains in this in­ter­view how providers could bet­ter un­der­stand how th­ese types of data con­nect if they

Modern Healthcare - - REGIONAL NEWS - By Adam Ruben­fire, Mod­ern Health­care Cus­tom Me­dia


Anita Ma­hon iden­ti­fies and drives strat­egy to de­liver in­no­va­tion with the power of data and cog­ni­tive in­sights for the Value-Based Care busi­ness of IBM Wat­son Health. She has spent the last 12 years in the health­care in­dus­try - with more than 25 years of ex­pe­ri­ence in cor­po­rate strat­egy and prod­uct de­vel­op­ment.

What’s driv­ing the con­ver­gence of clin­i­cal and fi­nan­cial data?

AM: Many providers are try­ing to un­der­stand what val­ue­based pay­ment mod­els mean for them. What­ever your level of ex­pe­ri­ence has been with th­ese new risk-based mod­els, you should be able to see how dif­fer­ent parts of your or­ga­ni­za­tion are in­ter­act­ing to con­trib­ute to those out­comes. It’s dif­fi­cult to man­age in si­los, be­cause to un­der­stand risk at the pa­tient level and man­age it at the pop­u­la­tion level, you must have the in­sights from bring­ing those dif­fer­ent data sources to­gether.

Why do emerg­ing pay­ment mod­els de­mand this ad­vanced an­a­lyt­ics ca­pa­bil­ity?

AM: Provider or­ga­ni­za­tions are un­doubt­edly more com­plex than they were a decade ago, with wider net­works of in­pa­tient and out­pa­tient fa­cil­i­ties, and you have an equally com­plex re­im­burse­ment sit­u­a­tion: the met­rics, the amount of risk you’re tak­ing on and the pe­riod for which you’re at risk is dif­fer­ent in each fa­cil­ity. You can’t come up with a unique so­lu­tion for ev­ery new pay­ment model, so I think the only way to sur­vive is to get more in­sight into what drives in­creased costs and in­flu­ences out­comes. Not every­body made money on some of th­ese new mod­els at first – prob­a­bly most didn’t. For some, I think it’s be­cause they didn’t have that indepth un­der­stand­ing of the costs and risks re­lated with each step in the care process.

What role does tech­nol­ogy play in fus­ing clin­i­cal and op­er­a­tional data?

AM: It’s more than just putting the data to­gether. It’s in­te­grat­ing the data, link­ing the sources and re­lat­ing them. So­phis­ti­cated soft­ware helps link them in a mean­ing­ful way and cre­ate mean­ing­ful units of anal­y­sis, but you also need a part­ner who un­der­stands how to help you or­ga­nize it to give you ac­tion­able in­sights. There are cer­tainly data and com­put­ing tech­nol­ogy tools that can be brought to bear here, but there are also skills in an­a­lyz­ing clin­i­cal data, op­er­a­tional data and claims data that are vi­tal to help find in­sights across those dis­parate sources.

How can link­ing clin­i­cal and fi­nan­cial an­a­lyt­ics help providers iden­tify cen­ters of ex­cel­lence?

AM: Ev­ery step of the way. An­a­lyt­ics at the ser­vice line level can help you get a clear pic­ture of how you’re per­form­ing, and com­par­ing that to com­peti­tors helps you see where you are de­liv­er­ing su­pe­rior value. I an­tic­i­pate that go­ing for­ward even more providers will look to com­mu­ni­cate a ser­vice’s value to ma­jor pay­ers, as well as large em­ploy­ers. I see an­a­lyt­ics at the heart of that, be­cause if you want to in­vest in that sort of busi­ness de­vel­op­ment ac­tiv­ity, you need to un­der­stand what’s driv­ing your suc­cess, so you know what you can do to sus­tain it, com­mu­ni­cate it and de­liver it go­ing for­ward.

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