Are Your Population Healthcare Business Analytics in a State of Hypoxia?

Originally published by Fierce Healthcare


As health plans across the country scale Total Cost of Care (TCOC) initiatives, many are leveraging analytics solutions like Risk Manager™ to help standardize their analyses, lower costs, and improve outcomes.

By: Andrei Gonzales, VP of value analytics product management at Change Healthcare

Healthcare business analytics have come a long way over the past two decades. Today, health plans have more data than they can feasibly manage—and therein lies the problem. Payers find themselves in a situation where they have more data than time, so they need tools to guide them to actionable insights quickly. Many payers self-build their analytics and work with multiple vendors to piece together their mission-critical analytics. As value-based care programs mature and focus more on total-cost-of-care models, the utility of comprehensive analytics solutions has become clear to replace these self-built models.

While working with one customer on a proof of value, we showed him a report of emergency and urgent care by day of week for patients who were attributed a primary-care practice. There was a clear spike on Thursdays, showing that there must have been an access issue that was driving patients to seek higher-cost emergency care that could be addressed through better clinic scheduling and patient education. Our customer said the information was like oxygen. When he said that, I thought of weary mountain climbers who rely on oxygen to climb the world’s tallest peaks and how much more they can accomplish with the right support.

Change Healthcare’s TCOC solution, Risk Manager, essentially rounds up that dispersed data and concentrates it into oxygen tanks that health plans can use to continue their business-analytics ascent. It’s based on a flexible, analytic, and workflow platform to deliver the actionable intelligence needed to support each stage in the evolution of payment reform. The platform ingests data once to repurpose for multiple insights to easily address provider attribution, risk assessment, performance analysis, quality and HEDIS, as well as gap closure.

A single platform to enable your TCOC strategy

Risk Manager leverages the most complex and expansive array of analytic engines to deliver the insights payers need to create programs that manage TCOC. The platform gathers and ingests data from multiple sources and then analyzes that data using a variety of engines. The truly majestic insights come into view when the platform links data from multiple engines in meaningful ways, delivering intelligence payers can use to drive behavior change, optimize performance, and facilitate data-driven negotiations with providers. 

Without a comprehensive solution, payers must merge several data sets and engines and create logical reports from the combined analytics. Risk Manager connects analytics engines that typically stand alone, and it’s the logical connection of these engines that equips payers with insights they can’t get anywhere else. Rather than needing to dig deep for insights, payers receive intelligence specifically designed to support the functional components of TCOC and alternative payment model (APM) initiatives. In other words, the platform empowers health plans to transcend the complexity.

Over the past five to six years, we’ve seen a big focus on episodes of care and working with Accountable Care Organizations (ACOs) to curb unnecessary spend with specialist referrals. Although there are many solutions in the market for payers to use with their provider network, we’re finding that payers want a more comprehensive view to see how these programs overlap. They want to combine them in a rational way so they can, for instance, avoid paying double incentives to the same member for both primary care and specialist visits. Using Risk Manager helps payers spend less time building, connecting, analyzing, and maintaining these data sets and more time working with providers to address opportunities for improvement.

Combined analytic engines deliver actionable intelligence

APM and TCOC programs focus on reducing costs and improving quality. As programs advance, it becomes more and more difficult to find the next level of insights needed for continued improvement. The data is there. It’s available. It’s just too dispersed to do anything useful with it. Risk Manager’s analytic engines combine to provide clear, actionable intelligence for your TCOC and APM programs.

A minimal-lift, low-risk solution

Our experience in the market, combined with relationships with top payers and providers, allows us to release new content and modules quarterly. Because we do the work to assess impacts of new ICD, CPT, and other codes, payers can be quick to the market with minimal lift and low risk. From there, you can scale at your preferred pace and comfort level because the platform accounts for your risk tolerance.

Demonstrated value in lowering costs and improving outcomes

Health plans leveraging Risk Manager to support their APM and TCOC initiatives are achieving impressive results. Whether you want to implement a PCP-based TCOC model, a pay-for-performance model, or drive shared risk and savings from a population health standpoint, Risk Manager can provide the intelligence to take payers there. The bottom line? Risk Manager can help payers scale programs that drive behavior change, optimize performance and quality, and reduce total cost of care. 

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