The $4 trillion healthcare industry is a data-rich sector, and every healthcare player is trying to find a way to use information to drive better decisions, whether in the clinic or the boardroom.
There are significant, intersecting trends that make data-driven decisions even more critical, from regulatory uncertainty to declining reimbursement rates to growing competition from new players like Walgreens and Amazon.
"The healthcare industry is a negative sum game," said Hal Andrews, CEO of data science, analytics and market research firm Trilliant Health. "The underlying problem for everybody in the healthcare economy is that the silver tsunami of 10,000 people becoming Medicare eligible every day is replaced by just over 10,000 births, about half of which are Medicaid-eligible. The commercially insured patient is the lifeblood of the system for everybody, for health systems, for payers, for life sciences, for medical devices, and yet, it's a slowly eroding population. It's a shrinking pie. And when you think about game theory, you win a negative sum game by losing less than the competition."
Trilliant Health was founded seven years ago by combining three companies to take a different approach to providing data and analytics insights for healthcare organizations.
"Our goal is to make strategic analytics available to any stakeholder in the health economy," Andrews said in a recent interview. "
The company's thesis is that for decades, the U.S. health economy has operated as if the fundamental rules of economics—demand, supply and yield—do not apply.
"We want people to use data for strategy like they do in every other part of the economy, whether it's Procter & Gamble or Apple," Andrews said. "Every other industry in America uses data to develop evidence-based strategies, and only in healthcare do we rely on state hospital associations to report data from two years ago to decide what we're going to do in 2025. And so the whole thesis is, get as much data as you can to make the best decisions possible about the future."
In 2017, Aegis Health, a company that provided employer and physician-focused solutions, merged with Clariture Health, which provided consumer-focused digital marketing solutions. The new company, Trilliant Health, then folded in data and analytics company Expression Health Analytics.
A year later, in 2018, Trilliant Health banked $12 million in series A financing, consisting of more than $7 million of new equity capital, led by Noro-Moseley Partners, with participation from existing investors Martin Ventures, Nashville Capital Network and NueCura Partners.
In 2019, the company recapitalized with a major growth investment from Primus Capital.
Trilliant Health has expanded its data platform to offer market and predictive analytics for health systems, payers and life sciences companies and also built out a research arm. The company boasts that it works with eight of the 20 largest health systems, three of the five largest ambulatory surgery operators and two of the four largest life sciences firms.
Trilliant Health's data offerings include a provider directory with more than 9 million rows of data about suppliers of healthcare services, covering more than 2.9 million active physicians, a national demand forecast that projects future demand for healthcare services over 10 years across service lines and demographic segments along with health plan price transparency data and an application to manage network performance.
The company's analysis insights are based on third-party data resources and the company’s proprietary all-payer medical and pharmacy claims database that informs longitudinal patient journeys for more than 300 million Americans, according to the company.
As part of its efforts to democratize access to healthcare data, the company just opened up public access to its entry-level tier of its provider directory and the national version of its demand forecast on Databricks Marketplace.
There is a growing list of companies offering healthcare analytics, insights and data resources as well as consulting and research services. Companies like H1, Definitive Healthcare and Ribbon Health offer provider directories while Sg2, the Advisory Board and Clarify provide healthcare analytics. There are data vendors and aggregators like Turquoise Health, Truveta and Datavant and consultants such as Deloitte and McKinsey & Company.
Trilliant Health is building out its services and products in all these areas, including research, noted Andrews.
"We compete with everybody, which is not for the faint of heart," he said. "I would say the real competition in healthcare is the status quo.
Trilliant Health has become a one-stop-shop for analytical tools, noted Devin Carty, CEO of healthcare-focused venture capital firm Martin Ventures. Carty was the co-founder and CEO of Clariture and served as chairman of the board at Trilliant Health until 2019. He now sits on the Trilliant Health board.
"Trilliant Health has evolved to being one of the leaders around data science and trusted reliability around analytics and trusted adviser around research," he said.
The thesis behind Trilliant Health was to provide more accurate market, financial and operational data to healthcare organizations to drive evidence-based strategies and business decisions, Carty said.
Many of the executives behind Martin Ventures, which backs Trilliant Health, are former hospital operators, he noted.
"What we learned from running acute care hospitals is that a lot of the data assets that we were leveraging had a lot of flawed data. We were making multibillion-dollar decisions and buying hospitals based on flawed data," he said. "Trilliant Health has been able to go straight to the data sources, frame that analytics and provide these hospital systems with clean data in the [business intelligence] layer to help them make informed decisions."
The company collects data at the individual patient and provider levels, including from patient data from clearinghouses, aggregators, payers, health systems and provider groups along with social determinants of health data and provider data. New price transparency rule also have opened up access to machine-readable files from health plans and self-insured employers.
Understanding and measuring network performance is critical to strategic decision-making, Andrews said.
Everything in healthcare begins with a provider decision, he noted. "Everybody's network performance is impacted by these individual physician-patient interactions. At the core of what we do, we're really good at understanding those individual physician-patient interactions," he said.
"Everybody knows that healthcare data is messy. We collect a lot of it and we do a lot of work to clean it up and to organize it," Andrews said. "We use a lot of machine learning and advanced analytics techniques to build predictions about what will happen in the future."
All healthcare is local
The historic approach to predictive models in U.S. healthcare is a national model, Andrews noted.
"A lot of them are built upon, basically, Census Bureau projections, plus the national ambulatory medical care survey, which has a lag period of about six years. Underneath some of these models is this notion that the disease burden in America is going to translate into more demand. The problem with that is that although Americans are getting sicker, and Americans are becoming more obese, the complexity that brings to their pathology does not relate doesn't turn into a one-to-one relationship," Andrews said.
"These historic models of demand have just assumed since there were more Americans and they were getting sicker that there will be more demand. In fact, hospital inpatient demand has been going down since 2008. Total surgical demand in the country has been pretty flat for the past seven years," he added.
Trilliant Health takes a different approach by offering data analytics and insights down to the local level to give health systems an understanding of market share and local market dynamics. The aim is to help health systems and other organizations better invest their resources based on more accurate healthcare demand forecasts, executives said.
"The demand trends in Dallas are not the same as in Topeka, which is different than in Charlotte. We focus very specifically on service line demand at the local level," Andrews said. "With something as capital intensive as healthcare, if you're investing too much money in something for which there's not going to be demand, we're going to end up where we already are, which is we will have over-invested in supply for things that aren't in demand."
The company offers an application that layers machine learning over its massive data sources to help health systems more accurately benchmark against market peers. Trilliant Health then offers advanced predictive analytics and demand forecasting tools.
"You start with a benchmark of understanding where you are, and then you start to think about how you develop plans to get to where you want to go," Andrews said.
Rethinking growth strategies in a changing market
Trilliant Health's analytics and research capabilities are vastly different today than seven years ago.
"When we brought the three companies together, we had an analytics platform that needed to be reworked. It needed to be rewritten and redeveloped, and it was very inflexible," Andrews said.
Trilliant Health's growth strategy was quite a bit different from many other companies. "We didn't start with a small solution that we went to the smallest customers in the market and then work our way up. We started with this massive analytics platform that very few people could understand and sold it to the largest customers in the industry," he said. "Our evolution over the past few years has been to deconstruct that massive analytics platform into discrete applications that anybody could use."
As healthcare shifts to be more consumer-centric and competition ramps up with newer players like Walmart, Amazon, CVS and Walgreens pushing into healthcare services, health systems recognize that they need a new approach to analyze their markets.
AdventHealth, one of the largest faith-based nonprofit providers in the country, leans on Trilliant Health's strategic forecasting it plots its growth strategy, according to David Banks, the health system's chief strategy officer.
"They have helped us rethink our markets through the use of the data they have from claims, and now with obviously price transparency, all the claims data that's available, they've allowed us to fundamentally rethink the way people buy healthcare in the markets we serve and how we approach our markets," he said. "Trilliant Health puts a consumer lens on the data showing here's where people in the communities you serve are actually buying their healthcare and it changes the way you think about things because it shows where people's dollars are actually going. It allows you to look at a market and say, 'Where is 100% of the market shopping for the healthcare services they need?' It changes the way we think about how we are building and deploying the services that we want to provide."
AdventHealth, which is affiliated with the Seventh-day Adventist Church, operates 51 hospital campuses and hundreds of care sites in diverse markets throughout nine states. The health system reported nearly $16 billion in its fiscal 2022.
These analytical insights fit into AdventHealth's 2030 strategic plan to become the "preeminent faith-based consumer-focused clinical care company," Banks said. "We're looking at, how do we as a health system start to engage with people before they are patients, helping them find the healthcare solutions they're looking for, and become much more consumer-friendly in their interactions with the system?" he noted.
The health system is evaluating how to redesign its services and its consumer-facing apps and digital interface and appointment scheduling, he added.
Taking a more consumer-centric approach means recognizing the importance of convenience and having easier access to healthcare services over specific providers or brand loyalty, Banks noted.
"It's a little bit of the Amazon dynamic. I may love my local retailer, but when I can go to a website and have something drop shipped to my door the next day, my brand loyalty to that retailer on Main Street, as much as I may love them, just changes," Banks said. "In healthcare, Trilliant Health's insights are helping us rethink how that consumer interface should go and the changing attitudes of consumers in terms of what they're willing to try. A higher desire to try virtual options, more convenient, low-price options for a lot of their healthcare needs."
These market and demand insights help provide guidance at the governance level, the planning level and the market assessment level, according to Banks. "We've just found them to be very good at that, being able to take that data and turn it into meaningful insights that affect planning and service delivery," Banks added.
As healthcare become more competitive and complex, healthcare organizations will need detailed data to guide their strategies, Carty noted.
"The power to start informing consumer choice, particularly for employers, to start making better decisions, I think that's the big opportunity," Andrews said. "The industry is too big for any one company to do it. I'm sure there will be a bunch of people doing it. Anybody who's trying to help providers make better strategic decisions, to help payers make better strategic decisions, and especially consumers make better strategic decisions, I'm glad for anybody to join that effort, and we all need everybody moving in that direction."