Hospitals, despite ongoing convergence between various healthcare stakeholders, still stand apart in their unique reporting needs and particular financial concerns. Unlike consumers, providers, payers and employers who stand to benefit financially from value-based approaches, hospitals have been challenged by the fact that population health and value-based payment structures hurt their traditional business models, often driving down margins. In fact, earlier this summer, hospital profitability faced its first decline of the year, triggered by lower patient volume (presumably driven in part by the shift to preventive, patient-focused, value-based care approaches) and "the inability of many hospitals to rapidly cut expenses" to adjust to this changing landscape.
While hospitals as a whole are still more profitable than the insurance or pharmaceutical industries, recent market trends and the push for consumer price transparency are forcing hospitals and health systems to prepare for a world where profitability is not assured and patient satisfaction as well as quality of care are the main harbingers of long-term success. Given this reality, here are some specific use cases for applying population health analytics most meaningfully for hospitals while also benefiting their patients and partners:
- Better Support for CMS Reimbursement Models: One source of increased pressure for hospitals to further engage in value-based care is CMS. To succeed in CMS-specific arrangements, hospitals need tailored, specific reporting that may be particular to certain conditions or even certain states or locations.
It is clear that better reporting related to CMS programs would be beneficial to hospitals, particularly if such reporting contained actionable insights. Hospitals and health systems are in need of next-step solutions around how to better performance related to quality, cost, safety and patient experience.
- Analytics Specific to Small and Rural Facilities: Smaller or rural facilities are in need of specific types of reporting that help them prepare for value-based care while optimizing operations and financial performance within their current, resource-limited structure. In fact, part of the reason why CMS penalties don’t drive down infection rates is that the failing hospitals simply don’t have the financial backing—or the hospital-employed physician staff-- to fix the problem.
All hospitals and health systems could also benefit from more connected systems for collecting and analyzing social determinants of health (SDoH) data, but rural and smaller facilities in particular have much to gain from SDoH analytics given the specific populations they serve across Medicare and Medicaid plans.
- Reporting Specific to Outpatient Services: Part of succeeding with changing CMS guidelines is that there is a closing gap between hospital inpatient and outpatient revenue. The shift to outpatient care requires hospitals and health systems to more closely track utilization of facilities that span beyond the ER, particularly for hospital systems with primary care, urgent care clinics, specialty practices and other outpatient services that are part of their larger organization or network.
- Analytics around Staffing and Operations: While hospitals continue to acquire and employ their own physician groups, a competitive labor market means that some physicians are leaving for independent practices. Further, with physician staffing a major expense for hospitals regardless of whether beds are filled, population health analytics around physician performance is a critical need for hospitals. There is, for example, already evidence that predictive analytics can help hospitals and physician groups appropriately staff high-cost centers like emergency rooms.
- Improved Patient Experience: Finally, hospitals can leverage population health analytics to continue to serve their patients in a market where competition for business is increasingly difficult. By understanding SDoH, staffing needs for particular times, why certain procedures should be moved to outpatient settings to save patient and hospital dollars, hospitals will be catering to patients' desire for cost transparency and personalized healthcare while supporting their own bottom line and quality of care ratings.
Overall, hospitals and health systems have a need for population health analytics across several specific areas, but according to a recent survey, less than 22% of hospital respondents polled were using analytics for population health. By keeping in mind that hospitals have financial concerns about the move to value-based programs--but that there are also many areas where supporting hospitals with analytics would simultaneously meet CMS, patient and physician needs—vendor partners are delivering hospital and health system clients the targeted set of insights required for success in today’s current market.