NEW STRATEGIES FOR

MANAGING COSTS ACROSS

POPULATIONS AND NETWORKS
Analytics steer healthcare organizations to a 360-degree
view for improved clinical and financial outcomes

IN PARTNERSHIP WITH
SCIO NEW STRATEGIES FOR MANAGING COSTS
ACROSS POPULATIONS AND NETWORKS
Analytics steer healthcare organizations to a 360-degree
view for improved clinical and financial outcomes

Healthcare organizations have little trouble naming their top clinical cost
drivers, but they readily admit they’re still stumped when it comes to
determining their total cost of care. Scattershot data practices, financial
constraints, and IT and EHR limitations continue to cause information
gaps. Without meaningful data, providers face significant challenges in
the near future as they move to value-based care and seek to improve
care quality while lowering costs. This is the consensus of the 142
Rose Higgins healthcare leaders who participated in the August 2017 HealthLeaders
Media Buzz Survey Exploring Care Costs.

A GROWING NEED FOR ACTIONABLE INFORMATION

Survey respondents, largely from provider organizations, identified their
top clinical cost drivers while shedding light on their data struggles
and other factors impacting patient and financial outcomes. Among
the survey highlights, pharmacy spending was a leading cost driver
(54%), underscoring the pressure point of rising drug costs, especially
when it comes to chemotherapy, specialty pharmaceuticals, and ICU
Dr. Kevin Keck
medications. Other major cost centers included inpatient medical and
surgical care spending (45%), chronic disease management (34%), and
specialty care physician services (33%).

The recent survey validates one of the greatest challenges to

reducing care costs is around the inability to put meaning-
ful, actionable information into the hands of those bearing the
weight of making clinical, financial, and operational decisions.
—Rose Higgins, President, at SCIO Health Analytics

“Rising healthcare costs are no longer just a focus from the

organizations that deliver and administer care,” says Rose Higgins,
president, at SCIO Health Analytics®. “Consumers are also taking a
share in the need to better manage healthcare spending as their out-
of-pocket costs continue to rise. The recent survey validates one of the
greatest challenges to reducing care costs is around the inability to put
meaningful, actionable information into the hands of those bearing the
weight of making clinical, financial, and operational decisions.”

Based in West Hartford, Connecticut, SCIO Health Analytics® is a leading health analytics
solution and services company. www.sciohealthanalytics.com 2
NEW STRATEGIES FOR MANAGING COSTS ACROSS
POPULATIONS AND NETWORKS

VALUE-BASED CARE LEADS TO NEW DATA SETS

Indeed, 58% of respondents cite highly fragmented data as their top
roadblock to determining the total cost of care, while 20% also say their
top issue is a lack of resources. Respondents say they lack access to
several data types critical to understanding their organization’s total cost
of care effort, including socio-economic (57%), postacute care (44%),
and behavioral (32%).

“Hospitals have billing information, but the survey results indicate they
are starving for more data sets,” says Kevin Keck, MD, chief medical
officer at SCIO Health Analytics. “Among other things, they need more
information to assess patients and develop targeted discharge plans;
otherwise, they are driving blind.” Dr. Keck is referring to outpatient
claims as well as socio-economic, pharmacy, postacute, EMR, and

The platform is burning. Those health systems that see that

and create strategies to get the data and insights that they
need are going to be the winners.
—Kevin Keck, MD, chief medical officer at SCIO Health Analytics

other data, all of which should be layered in with the billing information to
produce a 360-degree view of the patient. As healthcare providers seek
to go beyond simply understanding and predicting the clinical history of
their patients, creating effective data layers is more critical than ever. In
today’s landscape, considering human behaviors and other motivating
factors can be the difference that spurs a patient to take action.

In particular, socio-economic information is becoming more important as

healthcare organizations adopt value-based initiatives, says Keck. Socio-
economic indicators are key to helping hospitals understand their payer
mix and self-pay exposure. At the same time, postacute care data is
also becoming essential, especially for those organizations that take on
risk for cancer and total joint care.

In the past, hospitals have been reluctant to invest in obtaining new

types of data because of their singular focus on wanting to understand
their fixed and variable costs, which are better predictors of the bottom
line as opposed to the total cost of care. But this is changing as they
face an uncertain future.

Based in West Hartford, Connecticut, SCIO Health Analytics® is a leading health analytics
solution and services company. www.sciohealthanalytics.com 3
NEW STRATEGIES FOR MANAGING COSTS ACROSS
POPULATIONS AND NETWORKS

THE FUTURE IS ANALYTICS

The survey results also illustrate that as providers attempt to manage
competing priorities and take on value-based care business models,
they must also move to better manage costs across their populations
and networks. Key elements to value-based care success include
effectively developing care management programs to close care gaps,
identifying high-risk and high-cost patients early by understanding their
likelihood of engagement and compliance, as well as minimizing waste
by better managing utilization without impacting outcomes. Survey
participants agree and say developing care coordination efforts to close
care gaps (37%) and identifying high-risk, high-cost patients (31%) have
the greatest impact on patient and financial outcomes.

Rising healthcare costs are no longer just a focus from the

organizations that deliver and administer care
—Rose Higgins, president, North America at SCIO Health Analytics

As such, when they pair the right data with advanced analytics,
providers gain valuable insight into population and performance trends,
allowing them to personalize care delivery while improving quality and
financial outcomes. A well-planned data and analytics strategy can
help healthcare organizations access, integrate, and manage data from
across their network. Providers who have a grip on costs are investing in
data and analytics solutions that address their top analytics challenges.
Healthcare leaders say these challenges include an inability to integrate
clinical and financial data (52%), poor insights from current IT operations
(51%), and an inability to accommodate unstructured data (46%).

An advanced analytics program should have predictive information—

which looks at risks—along with prescriptive data, which identifies gaps
in care and pinpoints where to focus resources, says Keck. But the
program doesn’t require extensive infrastructure, additional supervisors,
or even software. For instance, the hospital discharge process for
chronically ill patients is important. More effort must be made in
transitioning patients from inpatient to outpatient settings, as the sicker
the patient, the more risk and possible care gaps that patient has. Data
analytics enables providers to focus their efforts on these patients to

Based in West Hartford, Connecticut, SCIO Health Analytics® is a leading health analytics
solution and services company. www.sciohealthanalytics.com 4
NEW STRATEGIES FOR MANAGING COSTS ACROSS
POPULATIONS AND NETWORKS

ensure all of their care needs are met as they transition home or to
postacute care. They must also ensure they don’t return to the hospital
due to lack of oversight at any step in the process, such as during
transportation home, when prescribing medications, or when making an
appointment for a home health visit. Using analytics, providers drill down
to patient-level data and follow the correct pathways.

Ultimately, says Higgins, “without access to the right data and a method
of interpreting the data that is easy to consume, it is likely we as an
industry will continue to struggle to balance the cost of care being
delivered with the quality of care which should be delivered.”

Keck concurs. “The platform is burning. Those health systems that see
that and create strategies to get the data and insights that they need are
going to be the winners.”

Based in West Hartford, Connecticut, SCIO Health Analytics® is a leading health

analytics solution and services company. It serves healthcare organizations
across the continuum; including provider groups health plans, PBMs, and
global pharmaceutical companies. SCIO provides predictive analytic solutions
and services that transform data into actionable insights, helping healthcare
organizations create the understanding that drives change through care,
network and reimbursement optimization as well as commercial effectiveness.

www.sciohealthanalytics.com

Produced by HealthLeaders Custom Solutions, © H3.Group

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