Today's healthcare environment presents nearly unending questions for hospital and health system leaders: How will healthcare reform affect my organization? How should I align with physicians? How can I mitigate financial losses? What the industry needs, perhaps more than ever, is more information. At the same time, the proliferation of electronic medical records, computerized physician order entry systems and other technologies seems to capture more data than healthcare providers have ever had access to before.
The trick is converting readily available data into usable information. John R. Thomas, CEO of physician alignment firm MedSynergies, explains how starting simple and aligning with physicians can help hospitals leverage data to gain market share.
Back to basics
The amount of data available to hospitals and health systems from new technology and data analytic firms can be overwhelming for hospital leaders. Organizations have to start somewhere, however, and the best place to start is with existing hospital systems, according to Mr. Thomas. "Use whatever you have now. Data in the hospital is where you have to start because it is the most readily available," he says. For example, hospitals can capture basic information, such as patients' age, sex, race and zip code, using existing systems. Similarly, a primary care physician can easily determine the number of patients who have not come in for a wellness exam in the last year; the physician can then use this data to reach out to these patients and identify ways he or she can meet the patient's needs.
"Most clients we see today are underutilizing existing data," Mr. Thomas says. Hospitals and health systems do not need to have an electronic medical record or participate in an accountable care organization to begin accessing relevant data to meet the community's needs. "Regardless of where you are in the life cycle of healthcare evolution, start now," he says.
Expensive, new technology is not necessarily the key to better information. "One of the issues is that people believe technology alone is going to give them the answer," Mr. Thomas says. "[People] have overcomplicated healthcare information because everybody wants the perfect answer. There is no perfect answer. They have to get started with high-level manual [processes] in the beginning."
Eventually, hospitals will move toward a strategy in which existing systems are used in tandem with new technology to look at data through both a bottom-up and top-down process. However, a truly integrated system of clinical, financial and operational data is a long way away based on organizations' current infrastructure abilities, according to Mr. Thomas. Hospitals have to first master current accounting and management systems before adding more complex technology. "It's critical to start somewhere and to build incrementally," he says.
Converting data into information
One of the challenges in using data to gain market share is being able to convert raw data into information. Currently, healthcare has a great deal of data but little information, according to Mr. Thomas. Information systems should provide hospitals guidance in which patients to target based on clinical and financial data. The bottom-up approach of using existing, readily available data can help hospitals translate data into usable information because it is simpler.
More complicated systems may yield very specific data that, while prodigious, may not be valuable to a healthcare organization trying to increase revenue. For example, data that breaks patients down by income level, marriage status, number of children and the children's medical status in addition to general demographics provide interesting statistics but do not necessarily help a hospital answer the question "How can I more effectively meet the needs of my patients?" Mr. Thomas says.
To answer this question, healthcare organizations should begin by looking at the local population's demographics and other existing data to identify trends and opportunities to reach more patients. These opportunities may come in the form of calling patients to give or solicit information, such as whether the patient is taking the correct medication. For example, a hospital with a high rate of Medicaid emergency room visits may indicate a need for primary care in the community. To respond to this information, hospitals can consider bringing a primary care practice into the hospital and partnering with a pharmacy or federally qualified health center to educate patients on preventive care, Mr. Thomas suggests.
Optimizing revenue cycle processes
A major source of hospitals' existing data is the revenue cycle system. Before gathering data from the system, however, hospitals need to first optimize their revenue cycle processes. One of the biggest problems is inconsistency in how providers in the same group use the revenue cycle system, according to Mr. Thomas.
For example, preregistration processes for acquiring and documenting patient information are often variable and may cause some demographic information or other data to be omitted from the hospital's records. "You can't start off looking for information. You have to make certain data processes in the beginning are followed and complete so the information converts in the back and becomes meaningful," he says.
Once processes are optimized, hospitals should designate someone to be responsible for analyzing data. Mr. Thomas suggests this role should be a separate staff position, as it is a long-term responsibility and not a project that has a definitive ending. Recruiting someone outside the healthcare industry, such as a marketing or finance expert, can be beneficial to the hospital by introducing a new perspective, Mr. Thomas says. This person should ask general questions about how to serve patients more effectively and efficiently. Working with nurses, physicians and other clinicians, they can develop solutions to any gaps of care in the community found through data analysis.
For instance, Mr. Thomas says the revenue cycle system may capture certain data on chronic obstructive pulmonary disease patients over the age of 65. The analyst should ask, "What can we do to help these patients?" Nurses could then suggest evidence-based measures, such as giving home healthcare visits and calling patients to confirm they are following their medication regimen. "Having people ask high-level questions — 'What should we do with patients?' — is where we should start," Mr. Thomas says. "It's a way to start providing the real value of information."
Physician alignment predicts success
A useful source of data besides the revenue cycle is physicians. By aligning with physicians in the community, hospitals can access their data to have a more complete picture of the patient population. Physicians' data on patients' appointments, for instance, can reveal trends about what type of patients are likely to miss yearly wellness exams.
This data is important because it can predict which patients will seek the organization's services, which sets it apart from hospitals' data, which has less predictive power, Mr. Thomas says. Requiring appointments allows physicians to allocate resources appropriately each day depending on which patients are scheduled to come in and what their medical needs are. Hospitals, in contrast, have less ability to predict what patients will come in on a day-to-day basis.
Whether hospitals employ physicians, enter into a co-management agreement or partner with them in a different way, working with physicians to use existing data is essential to generating valuable information, Mr. Thomas suggests. "Alignment is going to happen either with the health system and doctors, or payors and doctors, or doctors and doctors; whoever formally aligns with the doctors correctly wins the game in terms of patient market share," he says. "Patient market share is a function of physician and ambulatory care models."
Data analysis can keep the boat afloat
Analyzing readily available data from the hospital's revenue cycle system and aligned physicians can enable the hospital to more directly target patient populations for services. In addition, hospitals can leverage data to improve access to care and the quality of care. "The impact of providing the right care at the right time is worth a lot of money, especially in the future," Mr. Thomas says. "You can't put a dollar value on it."
Furthermore, garnering usable information from data may be required for hospitals and health systems as healthcare reform emphasizes health for patient populations and quality improvements. "If a health system can't manage and track patients through physicians, it's going to be at a competitive disadvantage," Mr. Thomas says.
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The trick is converting readily available data into usable information. John R. Thomas, CEO of physician alignment firm MedSynergies, explains how starting simple and aligning with physicians can help hospitals leverage data to gain market share.
Back to basics
The amount of data available to hospitals and health systems from new technology and data analytic firms can be overwhelming for hospital leaders. Organizations have to start somewhere, however, and the best place to start is with existing hospital systems, according to Mr. Thomas. "Use whatever you have now. Data in the hospital is where you have to start because it is the most readily available," he says. For example, hospitals can capture basic information, such as patients' age, sex, race and zip code, using existing systems. Similarly, a primary care physician can easily determine the number of patients who have not come in for a wellness exam in the last year; the physician can then use this data to reach out to these patients and identify ways he or she can meet the patient's needs.
"Most clients we see today are underutilizing existing data," Mr. Thomas says. Hospitals and health systems do not need to have an electronic medical record or participate in an accountable care organization to begin accessing relevant data to meet the community's needs. "Regardless of where you are in the life cycle of healthcare evolution, start now," he says.
Expensive, new technology is not necessarily the key to better information. "One of the issues is that people believe technology alone is going to give them the answer," Mr. Thomas says. "[People] have overcomplicated healthcare information because everybody wants the perfect answer. There is no perfect answer. They have to get started with high-level manual [processes] in the beginning."
Eventually, hospitals will move toward a strategy in which existing systems are used in tandem with new technology to look at data through both a bottom-up and top-down process. However, a truly integrated system of clinical, financial and operational data is a long way away based on organizations' current infrastructure abilities, according to Mr. Thomas. Hospitals have to first master current accounting and management systems before adding more complex technology. "It's critical to start somewhere and to build incrementally," he says.
Converting data into information
One of the challenges in using data to gain market share is being able to convert raw data into information. Currently, healthcare has a great deal of data but little information, according to Mr. Thomas. Information systems should provide hospitals guidance in which patients to target based on clinical and financial data. The bottom-up approach of using existing, readily available data can help hospitals translate data into usable information because it is simpler.
More complicated systems may yield very specific data that, while prodigious, may not be valuable to a healthcare organization trying to increase revenue. For example, data that breaks patients down by income level, marriage status, number of children and the children's medical status in addition to general demographics provide interesting statistics but do not necessarily help a hospital answer the question "How can I more effectively meet the needs of my patients?" Mr. Thomas says.
To answer this question, healthcare organizations should begin by looking at the local population's demographics and other existing data to identify trends and opportunities to reach more patients. These opportunities may come in the form of calling patients to give or solicit information, such as whether the patient is taking the correct medication. For example, a hospital with a high rate of Medicaid emergency room visits may indicate a need for primary care in the community. To respond to this information, hospitals can consider bringing a primary care practice into the hospital and partnering with a pharmacy or federally qualified health center to educate patients on preventive care, Mr. Thomas suggests.
Optimizing revenue cycle processes
A major source of hospitals' existing data is the revenue cycle system. Before gathering data from the system, however, hospitals need to first optimize their revenue cycle processes. One of the biggest problems is inconsistency in how providers in the same group use the revenue cycle system, according to Mr. Thomas.
For example, preregistration processes for acquiring and documenting patient information are often variable and may cause some demographic information or other data to be omitted from the hospital's records. "You can't start off looking for information. You have to make certain data processes in the beginning are followed and complete so the information converts in the back and becomes meaningful," he says.
Once processes are optimized, hospitals should designate someone to be responsible for analyzing data. Mr. Thomas suggests this role should be a separate staff position, as it is a long-term responsibility and not a project that has a definitive ending. Recruiting someone outside the healthcare industry, such as a marketing or finance expert, can be beneficial to the hospital by introducing a new perspective, Mr. Thomas says. This person should ask general questions about how to serve patients more effectively and efficiently. Working with nurses, physicians and other clinicians, they can develop solutions to any gaps of care in the community found through data analysis.
For instance, Mr. Thomas says the revenue cycle system may capture certain data on chronic obstructive pulmonary disease patients over the age of 65. The analyst should ask, "What can we do to help these patients?" Nurses could then suggest evidence-based measures, such as giving home healthcare visits and calling patients to confirm they are following their medication regimen. "Having people ask high-level questions — 'What should we do with patients?' — is where we should start," Mr. Thomas says. "It's a way to start providing the real value of information."
Physician alignment predicts success
A useful source of data besides the revenue cycle is physicians. By aligning with physicians in the community, hospitals can access their data to have a more complete picture of the patient population. Physicians' data on patients' appointments, for instance, can reveal trends about what type of patients are likely to miss yearly wellness exams.
This data is important because it can predict which patients will seek the organization's services, which sets it apart from hospitals' data, which has less predictive power, Mr. Thomas says. Requiring appointments allows physicians to allocate resources appropriately each day depending on which patients are scheduled to come in and what their medical needs are. Hospitals, in contrast, have less ability to predict what patients will come in on a day-to-day basis.
Whether hospitals employ physicians, enter into a co-management agreement or partner with them in a different way, working with physicians to use existing data is essential to generating valuable information, Mr. Thomas suggests. "Alignment is going to happen either with the health system and doctors, or payors and doctors, or doctors and doctors; whoever formally aligns with the doctors correctly wins the game in terms of patient market share," he says. "Patient market share is a function of physician and ambulatory care models."
Data analysis can keep the boat afloat
Analyzing readily available data from the hospital's revenue cycle system and aligned physicians can enable the hospital to more directly target patient populations for services. In addition, hospitals can leverage data to improve access to care and the quality of care. "The impact of providing the right care at the right time is worth a lot of money, especially in the future," Mr. Thomas says. "You can't put a dollar value on it."
Furthermore, garnering usable information from data may be required for hospitals and health systems as healthcare reform emphasizes health for patient populations and quality improvements. "If a health system can't manage and track patients through physicians, it's going to be at a competitive disadvantage," Mr. Thomas says.
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