Measurement In Healthcare: Using Proactive Data Insights To Power Value-Based Care

Partnering with an insurer committed to transforming health data into engagement-building insights and better outcomes can help mitigate the rising costs of healthcare.

Proactive Data Makes Value-Based Care Work

Value-based care is a payment model focused on improving health outcomes and helping lower costs over time for both the employee and the employer. Emphasizing the quality of care patients receive over the quantity of services providers perform, value-based care helps ensure patients get the most value. This approach thrives on measurement in healthcare, particularly through data analytics.

Measuring value is trickier than counting up the number of treatments a patient receives in a given year. That's where proactive data comes in — using a patient's information to examine trends and predict what's likely to happen next.

Payers have vast collections of data, plus the technology to analyze it and apply lessons gleaned from it, meaning their role has expanded significantly from simply paying claims.

The data collected by payers and providers transforms data points into insights that can be used to predict the risk for chronic illness or hospitalization or the potential outcome of a treatment. Those predictions can then lead to recommendations to address illnesses early, avoid hospitalizations, or find the right treatment for a condition.

All these actions can save your organization money down the line and across your workforce. For example, Anthem’s Specialty Condition Management program realized a savings of $330 per engaged member per month in cost of care, according to the 2020 CarelonRx Drug Trend Report: Specialty Supplement.

The Role Of Data In Integrated Health Networks

One of the primary ways employers weigh in on value-based care is through the networks they offer employees within their health plans. Healthcare must be connected. Employer benefit programs can connect healthcare by using real-time connections, integrated solutions, and a personalized, simplified experience to proactively meet the health needs of their employees whatever they may be.

Healthcare is complex and the COVID-19 pandemic pushed people to seek care in different ways, mainly through digital and telehealth options. The demand for virtual care options is likely to stick around and is integral for health plans that aim to improve outcomes and reduce costs.

With the push to apply the data they already gather, providers are reporting metrics for health outcomes, quality, readmissions, and general measurements based on their performance. Health insurers develop value-based health plans with these providers by negotiating contracts and cultivating networks specifically designed to deliver high-quality care at a lower cost. Showcasing the quality of care in these networks helps drive employees to these care settings.

Network providers are chosen based on clinical measures, contracts, and a focus on outcomes-based care that ties payments to performance. These networks can also use virtual primary care for convenience and lower costs before guiding employees to in-person care with an in-network doctor.

Applying Measurement In Healthcare To Improve Employee Wellness

There are two main types of data to keep in mind here: predictive analytics and prescriptive analytics.

• Predictive analytics gather information, evaluate trends, and forecast what's likely to happen next. Employee data from health claims, wellness apps, and other sources are fed into large databases. Analytics programs identify gaps in care or risks for chronic disease.
  
  
• Prescriptive analytics go one step further and use the trends and expectations to recommend actions, promoting the whole-person health of your employees. Then, a digitally enabled benefits offering can provide lifestyle recommendations, virtual or in-person care options, and regular check-ins to keep people engaged with their long-term health.

By applying data to health benefits, your employees get personalized recommendations. Rather than general wellness tips, employees get actionable advice suited to their personal needs, whether that's diabetes management, heart disease prevention, weight loss, family planning, or something else.

Newer benefit offerings, such as high-performance, narrow networks, combine apps, online support, virtual visits, and access to high-quality yet affordable doctors to help ensure employees receive the right care at the right time.

This high level of personalization is all powered by data. With unprecedented levels of measurement in healthcare available, employers, insurers, and healthcare providers can work together to reimagine what’s possible for every moment of health.

The Virtual Primary Care experience is offered through an arrangement with Hydrogen Health.