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As the healthcare industry continues to transition to value-based care (VBC) models, financial risk is shifting away from the payers and toward the providers. Payers are looking to alternate payment models (APMs) and other strategies to drive more value to their members.
To succeed in an environment of shared risk, payers must extend theirdata分析和风险管理方面的专业知识。本文解释了这种用于医疗保健支付方分析的扩展方法,以及在风险管理环境中为支付方开发分析路线图的价值。
The first step in building an analytics strategy is to accept as guiding principle the words of W. Edwards Deming, “Without data you’re just a person with an opinion,” and make data an organizational imperative. The second step is to build a roadmap that leads to a data-driven culture. When payer organizations arrive at the data-driven destination, teams use analytics to identify opportunities and implement solutions to support new strategies, (e.g. enabling their providers to succeed in shared risk). Data drives decisions and actions.
通过遵循分析路线图,支付机构将成熟其对数据的使用和理解,从传统的描述性报告到高级预测分析。This transformation augments human intelligence, and providers and members can directly leverage its benefits:
A roadmap will help the payer navigate their own way through a minefield of potential risks associated with these challenges:
The well navigated data-driven journey through the minefield of risks will produce meaningful benefits, including the following six outcomes:
In the journey towards a data-driven culture, payers may partner with an analytics vendor or go it alone. Either way, an organization should use the Healthcare Analytics Adoption Model (Figure 1) as the context for a tailored analytics roadmap that progresses from a pre-enterprise data operating system to democratized data and, finally, to a data-driven cultures.
企业成立前的数据操作系统文化的电子表格孤岛,或分析的口袋,产生冲突的报告和对数据的冲突解释。这就导致了数据所有权的争夺、消费者长长的报告请求队列,以及分析师花费大部分时间寻找和收集数据。重点是获得正确的数据和获得正确的数据(即数据完整性和数据准确性)。
民主化的数据文化使常规报告自动化,并利用单一来源的精心策划的数据进行特别分析。治理团队在标准化定义和确定数据获取的优先级方面花费了大量时间。组织开始信任数据,并且随着自助服务应用程序和分析师生成的成员注册的可用性,报告队列显著减少。
当支付机构到达数据驱动的目的地时,他们使用分析来识别机会并实施解决方案以支持新战略(例如,使其供应商能够成功地分担风险)。2022卡塔尔世界杯赛程表时间数据驱动决策和行动。重点是利用启发性和预测性分析来加强VBC和人口健康管理。
As organizations mature in the use of data, they move from levels zero to nine (from fragmented point solutions to direct-to-consumer analytics and artificial intelligence) and progress through three key improvement categories:
Interestingly, as the organization matures its analytics adoption, it can reallocate human resources from lower levels, where they’re spending time on automatable tasks, to higher levels of analytic tasks. This allows its workforce to better apply its expertise (i.e., work at the top of their licenses), which reduces turnover.
Before adopting and executing an analytics roadmap, a payer organization should complete an analytics readiness assessment. The assessment identifies where an organization falls along the analytics adoption model—where it stands compared to industry standards—and ensures organizational expectations are in line with organizational capabilities.
分析合作伙伴应该提供分析准备评估。Health Catalyst, for example, offers an analytics readiness assessment with three components:
组织自我评估以关键数据消费者和/或消费者群体确定得分背后的细节;这些数据为上述领域的一对一访谈提供了信息。
The results of the analytics readiness assessment (Figure 4) give the organization a readiness score (low, medium, or high), recommendations for improving analytics readiness, and the starting point for a customized analytics roadmap for that organization in the context of the Healthcare Analytics Adoption Model.
The readiness assessment also generates a list of short-term and long-term recommendations in three categories to tailor the route on an organization’s analytics roadmap:
Category | Sample Recommendations (suggested waypoints to build into a roadmap) |
---|---|
People | 组织分析——考虑最佳实践中心和范围模型。 Educate analysts on data management and data architecture. |
Process | 同时扩展数据访问和数据治理。 Evaluate/adapt the Healthcare Analytics Adoption Model for the individual analytics journey. |
Technology | Compare current thedata warehouse堆叠数据操作系统的最佳实践。 消除多个重叠和过时的数据可视化工具。 |
The good news is that benefits begin accruing as soon as the organization executes the readiness assessment. Value builds through each phase of analytics maturity:
The analytics readiness assessment aims to help organizations determine if their analytics capacity is adequate and appropriate for succeeding in tomorrow’s healthcare environment. VBC models will mature as the inevitable context for addressing the rising costs of healthcare, and payers that mature their analytics capabilities in sync with the changes in the market will thrive.
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