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Accenture Outlook: Prescription for Change [Healthcare]

Accenture Outlook: Prescription for Change [Healthcare]

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Published by Accenture
A new information value chain—built on evidence-based insights—is emerging that could reconcile the divergent interests within the US healthcare industry. The ultimate beneficiary: the patient.
A new information value chain—built on evidence-based insights—is emerging that could reconcile the divergent interests within the US healthcare industry. The ultimate beneficiary: the patient.

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Categories:Business/Law
Published by: Accenture on Jul 14, 2011
Copyright:Attribution Non-commercial

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12/31/2013

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The journal o high-perormance business
Industry Report | Healthcare
Prescription for change
By Jim Golden, Ann Kieaber, John G. Edelblut and Kristina L. Gilbert
A new inormation value chain—built on evidence-basedinsights—is emerging that could reconcile the divergentinterests within the US healthcare industry. The ultimatebeneiciary: the patient.
This article originally appearedin the 2011, No. 2, issue of 
 
2
Outlook 2011
Number 2
Consider the following:
People in Mobile, Alabama,undergo four and a half timesas many heart bypass surgeriesas those in Pueblo, Colorado.Women in Missoula, Montana,undergo over three times asmany mastectomies as womenin Charleston, South Carolina.Residents of Miami, Florida,have 66 percent fewer kneereplacements than people inLincoln, Nebraska.
 
These examples—drawn from
TheDartmouth Atlas of Health Care
’s
analysis of 2005 Medicare data—paint a compelling picture of justhow much variability there canbe in the provision of healthcareacross the United States.Such inconsistencies within theindustry are not only regional,however. Even the practice stylesof individual physicians can varydramatically from one hospital af 
-
liation to another, while researchhas suggested that some doctors maycharge twice as much as others for essentially the same treatment.More than statistical anomalies, thesehigh levels of variability increasecosts, reduce overall effectivenessand impede the performance of thehealthcare system as a whole. Unlessthis unnecessary variability is ad
-
dressed, other efforts to improve thesystem are likely to fail.Industry participants have been awareof this systemwide variability for de
-
cades. But until recently, they lackedenough patient data in a format thatcould facilitate ready analysis; theyalso lacked the analytical tools toextract insights from that data. With
-
out accessible data that aggregatesthe actual experiences of thousandsor perhaps millions of patients—inother words, without medical evi
-
dence—healthcare practitioners todayoften rely on a mixed bag of training,intuition, personal experience andinstitutional policies to decide on acourse of treatment. The consequencesare grave, and include errors, limitedaccess to best practices and a mis
-
alignment of cost and quality of care.However, with the emergence of digi
-
tized patient records, coupled withthe ability to integrate and analyzeexternal information such as payer data, patient-reported information,physician networks and clinical trialsdata, the entire industry—doctors,hospitals, drugmakers and insurers—
 
has a new common currency for productive interaction that Accenturecalls analytics-driven evidence-based insights (see chart, page 3).The powerful combination of newinformation and evidence-based in
-
sight tools to leverage it has providedan extraordinary opportunity: tocreate a healthcare information valuechain linking stakeholders in waysthat ultimately lay the groundworkfor a classic, more symbiotic health
-
care value chain.Currently, the US healthcareindustry consists of producers (foexample, pharmaceutical companiesand medical device makers), payers(insurance companies, HMOs),providers (hospitals, pharmaciesand physicians) and government—
 
all working across the system in anuneasy, inefcient and often ineffec
-
tive alliance. The difcult nature of these relationships reects conict
-
ing economic interests. To realizebusiness value, each party relies ona limited, highly specic set of dataand analyses. Few take a systematic,holistic view of all of the evidencewithin a standardized framework.In fact, while some stakeholdersmight see the potential uses of anexpanded data set as an opportunityto collaborate, others view it as athreat to their business interests.
 
3
Outlook 2011
Number 2
 A Wharton School study found thatthe industry does not even have a value chain—in other words, thereis no coordinated effort amongparties, no broad strategic alliancesand no real sharing of knowledge. And given how fragmented theprovider universe is, there is littlecompetition to deliver the highestcustomer value at the lowestpossible cost. As a result, payers,providers and producers all actindividually to capture as much valueas possible—often at the expenseof patients.The new information value chain willreconcile these divergent interestswithin the industry. Several signi
-
cant hurdles must be overcome rst.But the benets from the pervasiveuse of an evidence-based insightsapproach could be substantial.Over time, evidence-based insightsderived from healthcare dataanalytics will create a kind of  virtual unication of all stakeholdersin the industry, with signicantbenets for each.For producers, an evidence-basedinsights approach would integrateexternally generated data regard
-
ing safety, epidemiology andhealth outcomes with internallyderived clinical and discoveryinformation. This would drivebetter decisions regarding strategicR&D across the pharmaceutical value chain.For payers, an evidence-basedinsights approach would helpidentify which treatments andtherapies work best for whichpatients, in what context and
Source: Accenture analysis
A new common currency
 Doctors, hospitals, drugmakers and insurers will be able to interact using commondata from a host of sources that has been integrated and analyzed. The data willcome from electronic patient records, payers, patient-reported information, physiciannetworks and clinical trials.
Payers
Claims and payment dataClinical outcomes dataBest practices data
Providers
Physician profile dataBest practices dataMarket research data
Patients
Patient profile dataElectronic healthrecord data (EMR andPHR, lab results)Personal financial data
Producers
Supply chain dataIndustry intelligence dataBenchmarking dataMarket research data
ControlcostOptimizerevenuePayersPatientsProducersProvidersImprovedquality of careand outcomesClinicalevidence

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