How to Efficiently Leverage Multiple Data Sources to Create Relevant Patient Experiences

According to Forrester Research’s customer experience index, even improving patient experience by one or two points can have an enormous impact on patient satisfaction and a health care organization’s bottom line. It’s the proverbial win-win. However, the same report indicates that not one company across any industry is earning marks of excellence for customer experience—not even Disney, the customer-first, customer experience poster child.

Health care organizations have been, and continue to be, invested heavily in patient experience to improve outcomes and lower costs. The potential to realize these improvements depends on the quantity, quality, and diversity of data available. The post-EMR implementation landscape and health app explosion are cranking out more data than clinicians or marketers can disseminate. Interoperability is a key and complex problem health care faces, but there are means of getting answers to patient experience questions quickly without wading through siloes of data and internal bureaucracy. The key is to get to actionable insights regardless of whether your data is your own or combined with third party data from public sources or private partners.

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Key for ACOs: Have Payer-Side Advisory When Negotiating Reimbursement for Value-Based Fees

Payer-Side-Insurance-Advisory

Last week I attended the Accountable Care and Health IT Summit in Chicago focused on Accountable Care Organizations (ACOs). The general belief that CMS’ MACRA and MIPS payment models are changing too fast for health organizations to adapt was common. And while there are great examples of companies using data and telehealth to impact population health and new technologies and patient processes that are both improving outcomes and costs, everyone is really figuring it out as they go.

A key issue is that of reimbursement. As ACOs coordinate and/or buy up physician practices, the missing piece is making sure they understand how to negotiate reimbursements with the payers, including private payers. As ACOs step into the role of ‘payvider’, as it’s been coined, a level of sophistication around contracting and risk analysis is required.

Private payers focus on commercial populations within their portfolio versus the general population health. Their populations can also come and go as companies move their health plans to other payers, which increases their investment risk.  Understanding where ACO and payers can come together to effectively delivery care at a lower price point is key to managing an effective ACO, for example: Medicare Advantage’s higher PMPM cost and disease burden could present an opportunity for a savvy ACO in this market.

Bottom line is that to optimize revenue opportunities ACOs need to have payer insight, contract negotiating skills, an understanding of federal legislation, and risk/reward analysis skills on their team when negotiating reimbursement contracts with payers.  Doing so will help ACOs better leverage their investments and reach the benchmarks of both the federal government and private payers.