Decisions with data: How analytics inform value-based partnerships

As the industry shifts to a future that values quality of care over quantity of visits, applying analytics to the right data enables health plans and providers to have strategic conversations to evaluate and deploy value-based models. Every step of the way — from strategy to execution — health care intelligence empowers collaborative decisions to ensure efficient care and sustainable growth.

Leaders who are exploring value-based initiatives must intimately know their market. Data not only allows leaders to understand where care gaps exist in their service area, but also feeds into financial models that can help providers and health plans decide how aggressively they should shift care to value-based contracts.

Health plans and providers should consider starting with polychronic populations, said Erik Johnson, vice president of
value-based care for Optum Advisory Services. Patients with multiple chronic diseases not only represent a significant
cost, but also present a prime opportunity for outcomes improvement.

Analytics can also help leaders determine the ideal pilot environment for the disease or challenge they’re attempting to influence. For example, a region may have high rates of chronic obstructive pulmonary disease (COPD), but if it doesn’t have depth of talent to effectively address this condition, it may not be the right place to start.

“When you have an understanding of where you have concentrations of patients and risk, it can help you understand not just the nuances of those regions, but also what partners are able to be integrated into the program,” said John Kontor, senior vice president of provider technology services at Optum Advisory Services.

A clear understanding of your market enables a new, data-driven conversation on partnership opportunities in which health plans and providers have common objectives to address cost and quality, together. “Prospective partners should also make sure they’re contractually aligned,” said Jay P. Hazelrigs, ASA, MAAA, vice president of Optum Advisory Services. “Do you have an equivalent ability to manage care, and are you willing to share data? Alignment in those areas goes a long way in enabling collaboration.”

Interventions don’t necessarily have to be costly to make a significant impact. Johnson points to a health system partner that had recently engaged in a risk-based contract with its state Medicaid agency and had observed a disproportionately high number of emergency department admissions for pediatric asthma. A data analysis of both clinical data from the provider and claims data from the state ultimately prompted the hospital to send social workers to the most problematic homes. The reports came back that the patients had inhalers and most of the parents didn’t smoke, but they had a furry common denominator: pets.

“They managed risk by buying them hypoallergenic vacuum cleaners,” Johnson said. “Data prompted this intervention, but the human element — the social workers — were still crucial in investigating the root cause. That’s where analytics lead to action.” To succeed in value-based care, both providers and health plans will need to address problems that have previously seemed out of their control but have a significant impact on outcomes. Data provides a common language that helps leaders understand how best to invest in community resources and spark a conversation with consumers to promote better access to care and healthier behaviors, Kontor notes.

Data must be shared with the right stakeholders to ensure that these efforts are effective. When clinicians, executives and their partners are all looking at the same data, everyone is on the same page as to “who” their patients are.

“If you don’t understand your patient and you’re not caring for them in a high-quality, cost-efficient manner, you run the risk of not being considered a good partner, which can be validated through analytics,” Hazelrigs said.

When actionable intelligence is shared among all stakeholders, partner organizations and their customers can make prompt, mutually beneficial decisions that mitigate risks from gaps in care. Translating data to action empowers leaders to make meaningful, appropriate decisions that are not in a vacuum.

Learn more about how Optum helps health plans and providers align for value-based care success at Optum.com/PartnersinValue.