Understanding Value at the Crossroads of Costs and Outcomes

Traditionally, clinical data has been siloed from financial and operations data, viewed with distinct implications. Anita Mahon, the Chief Strategy Officer of the Value-Based Care business of IBM Watson Health, explains in this interview how providers could better understand how these types of data connect if they wish to thrive as value-based care models continue to evolve.

AM: Many providers are trying to understand what value-based payment models mean for them. Whatever your level of experience has been with these new risk-based models, you should be able to see how different parts of your organization are interacting to contribute to those outcomes. It's difficult to manage in silos, because to understand risk at the patient level and manage it at the population level, you must have the insights from bringing those different data sources together.

AM: Provider organizations are undoubtedly more complex than they were a decade ago, with wider networks of inpatient and outpatient facilities, and you have an equally complex reimbursement situation: the metrics, the amount of risk you're taking on and the period for which you're at risk is different in each facility. You can't come up with a unique solution for every new payment model, so I think the only way to survive is to get more insight into what drives increased costs and influences outcomes. Not everybody made money on some of these new models at first – probably most didn't. For some, I think it's because they didn't have that in-depth understanding of the costs and risks related with each step in the care process.

AM: It's more than just putting the data together. It's integrating the data, linking the sources and relating them. Sophisticated software helps link them in a meaningful way and create meaningful units of analysis, but you also need a partner who understands how to help you organize it to give you actionable insights. There are certainly data and computing technology tools that can be brought to bear here, but there are also skills in analyzing clinical data, operational data and claims data that are vital to help find insights across those disparate sources.

AM: Every step of the way. Analytics at the service line level can help you get a clear picture of how you're performing, and comparing that to competitors helps you see where you are delivering superior value. I anticipate that going forward even more providers will look to communicate a service's value to major payers, as well as large employers. I see analytics at the heart of that, because if you want to invest in that sort of business development activity, you need to understand what's driving your success, so you know what you can do to sustain it, communicate it and deliver it going forward.