Healthcare’s transition from fee-for-service payment models to value-based care has eased the tension between payers and providers, allowing for a more collaborative approach when it comes to data sharing and analytics.
During a discussion at the SAS Health Analytics Virtual Forum, leaders with the Cleveland Clinic and Humana emphasized the importance of data partnerships as the healthcare industry continues to transition toward innovative payment models. New initiatives—like bundled payments for hip and knee replacements—have forced providers to re-engineer their approach to care, a transformation that relies on the ability to analyze and interpret patient data to provide more personalized care.
Previous payment models created “adversarial relationships” between payers and providers, said Chris Donovan, executive director of enterprise information management and analytics at the Cleveland Clinic. Now, those same companies take on an equal share of risk, which has fostered new data-driven partnerships.
“I think we’re really just scratching the surface of what we can do together,” he said, adding that government can play a role in fostering those relationships by building on programs that continue to emphasize value over volume, and by establishing standards for data quality.
“There are a lot of opportunities for government,” he said. “The experiments they have done show they can move the needle.”
Robert Sahadevan, enterprise vice president of consumer marketing and data analytics at Humana, added that analytics has helped the payer drill down into subpopulations and demographics to better understand how patients interact with the healthcare system, and then build personalized interventions.
For example, Humana has implemented a remote monitoring program for patients with congestive heart failure that includes wireless scales and an automated stream of patient-generated data. But they’ve found that intervention is better for some patients than others.
Sahadevan pointed to one particular member—an older woman—who looked forward to the daily calls and likely wouldn’t respond well to an automated approach.
“She calls it Humana, my friend who is calling,” he said. “I’m sure not everyone feels that way about their payer.”
The Cleveland Clinic is using remote monitoring and analytics to reduce costs and length of stay among specific patient populations. But Donovan agreed that patients need to be at the center of any analytics-driven interventions.
“Patients are going to be such a key part of this,” he said. “They need to have a vested interest in their health as well. That’s one of the challenges.”