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September 3, 2013

Healthcare Alliances Moving the Ball on Big Data

Isaac Lopez

It’s no secret that healthcare organizations in America face an enormous challenge as they try to bring big data solutions into the mix. We’ve reported extensively on the daunting data challenges that these organizations face in bringing big data to clinical intelligence.

However, these challenges aren’t stopping all progress – groups, such as the Premier healthcare alliance say they’re making headway in turning data into actionable analytics. The alliance, which is focused on performance improvement in healthcare through the use of technology, comprises 2,900 U.S. community hospitals and 100,000 alternate sites (i.e nursing homes, rehabilitation centers, and other non-acute facilities).

In addition to operating a purchasing network for the alliance, the group maintains a clinical, financial, and outcomes database that they says is based on 1 in every 4 U.S. patient discharges, including approximately $40 billion worth of annual provider purchases, and 2.5 million daily transactions. This is a treasure trove of data that they use to collaborate with alliance members to improve the quality of care and reduce costs. Recently, the group announced an alignment with Verisk Health, a healthcare risk management software provider that offers a predictive analytics suite aimed at population health management.

Among the problems that healthcare industry faces, according to the New England Healthcare Institute, is $38 billion dollars in overuse of emergency room visits for conditions that could have been treated in primary care, pointing to the need for proactive health management. To combat challenges like this, Verisk’s software uses event-based modeling to identify patients who are likely to end up in the emergency room, and prioritizes proactive care for these individuals in order to predictively bypass these future visits. The group has other software offerings, including predictive analytics for high risk individuals suffering chronic conditions, obesity management, quality-of-care tracking, and more.

Combining the Verisk tools with the Premier alliances collection of data and tools, they’ve developed a suite that they’re calling PopulationAdvisor, which they use to combine both claim data as well as clinical information to help providers make better operational and clinical decisions.

Today they announced that they’re putting the system to work with Carolinas HealthCare System, which they say is one of the first health systems without a provider-sponsored health plan that will integrate payer and provider data to improve health.

“Being able to integrate clinical and claims data provides a 360-degree view of the patient that helps physicians take specific actions, such as encouraging patients to take their prescription medications, which can improve overall health and help reduce hospital readmission rates,” said Michael Dulin, MD, PhD, medical officer for Analytics and Outcomes at Carolinas HealthCare System.

The new solution will aggregates risk-based payer analytics used by more than 450 healthcare and employer organizations giving Carolinas HealthCare System a more complete picture of patient care with a better understanding of outcomes and total cost, including care delivered outside the health system.

The group expects an array of benefits to come from the technology, including

  • Identify and manage high-risk populations (to intervene with current high-risk, high-cost patients and identify those with high risk and potential high cost in the future);
  • Discover gaps in care to improve clinical outcomes;
  • Profile physician and practice variation; and
  • Maximize performance incentives and differentiate quality using HEDIS, PQRS and ACO-33 measures.

While healthcare still has a lot of challenges to face as the industry modernizes, there are organizations cropping up to attack the needs of the space. It will be interesting to see how more of these organizations rise to the challenge, especially as we move into new mandates as the Affordable Care Act goes into effect in 2014.

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