The heated debate on the costs of health care has been conducted largely without facts based on analysis and metrics that could provide guidelines for improvement. The field for analytics should include the full lifecycle of the patient and the treatment of illness, including not only doctors’ care and service delivery but also the involvement of insurance companies, medical devices and life sciences that produce the medications. A complete picture must include not just numbers and quantitative measures but qualitative feedback on the balance of patients’ experience and satisfaction with the health care system. There is no doubt that this industry has significant room for improvement, but the question is whether the “system” wants to be microscopically analyzed to determine what has to be changed. Real improvement will require the industry to be smarter in analyzing not just data but speech and text that are used to transmit information via telephone and the Internet.
Hospitals, clinics and medical practices are forced to balance the desire to deliver the best quality of care with the increasing numbers of patients who get subsidized care or do not have insurance. To ensure the financial stability of service providers, analysts could compare the historical patterns of their operations with the set of services they propose to deliver and the expected timeframes. Such a patient and time-series level of analytics can provide a baseline for determining how to ensure sustainability of operations. At the same time, government entities at state and national levels have to be accommodated with detailed records and measurements of treatments for Medicaid, Medicare and state-specific rules and regulations. Insurance providers also need details of what treatment is provided so they can manage policies and profitability. By establishing better local and national benchmarks of operating and service metrics, the private and public sector can work together to determine the right adjustments to maintain quality and rein in costs while meeting patients’ expectations.
To do any or all of this, the people and processes employed across the health care industry must develop competencies to improve interactions along the patient service chain. The disparity of information systems among the many parties involved creates barriers to cooperation and will remain unless new operating and performance information exchanges are established to enable regional and national reviews of the costs of providing treatments.
Another high hurdle will be dealing with information privacy and security even at aggregated and nonpatient levels of detail; to overcome it will take advanced data integration and quality technologies that can establish secure formats for analysis. In the meantime, health care providers should seek out technology that can collect their data, prepare it for analysis and facilitate creation and publishing of metrics for planning and financial management purposes.
The insurance providers face increasing scrutiny of whether they are meeting the needs of their customers, the corporations and individuals insured for the range of health care issues, from coverage and copays to quality of care in relation to cost and ensuring proper fulfillment of services rendered. In today’s volatile economy, most individuals will not stay with one employer for their entire life, and as workforce turnover and change happen, so does the insured relationship. Insurance also needs to prepare for governmental pressures on pricing and more competition across state lines. Analytics used to generate metrics that tell the actual story of costs of treatments and doctors’ care on one side and margins on the other can become a valuable tool as pressure for transparency in health care continues to grow.
Another vital health care issue is competency and training of medical staff to provide the services that are necessary. The pace of education and advances in medicine and treatments requires continuous education. Workforce analytics in health care can help track the learning that is taking place along with the level of compensation for the care being provided. This is important as the work of Human Resources in recruitment and onboarding should be as efficient as possible in the effort to provide the highest quality care at every facility from hospital to doctor’s office. As well the expansion of governance, risk and compliance issues dictates that processes and measurements are in place to assess preventive steps are taken to provide adherence to policies for safety and treatment.
It’s time for this important industry to step forward and apply analytics that can be used for reporting, modeling and planning. For sophisticated and large-scale health care providers, predictive analytics can help provide worst- and best-case scenarios for emergency planning in terms of responsiveness and delivery systems. It can play a critical role in understanding how to provide preventive care through the Internet and by mobile technologies to minimize the number of visits that do not require in-person interaction with doctors or nurses. Health care providers will have to become more competent in the use of these technologies, which also can measure the value of the investments in streamlining health care operations.
Mark also blogs at VentanaResearch.com/blog.