Health care can represent a considerable expense for small business owners. Value-based care could help keep employee health affordable — with the right use of data, that is.
How Proactive Data Makes Value-Based Care Work
Value-based care is just what it sounds like — it’s a model that emphasizes the quality of care patients receive over the quantity of services providers perform, ensuring that patients get the best value out of their health care. Value-based care thrives off of measurement in health care, particularly through data collection and analytics. Providers working under value-based payment arrangements share data they collect to demonstrate outcomes, earning payment based on the value they deliver rather than the services provided.
Measuring value is trickier than measuring the number of treatments a patient receives in a given year. That’s where proactive data comes in. Using proactive data involves taking a patient’s information to examine trends and predicting what’s likely to happen next. Projecting health care costs and outcomes in both traditional fee-for-service and value-based care scenarios makes it possible to estimate the savings driven by an emphasis on value. But data is used for more than just measurements; it gives providers, payers and individuals a stepping stone to truly reform health care delivery.
Health care providers collect massive amounts of data about their patients’ health. A tertiary care hospital collects about 100 terabytes of patient data per year. For perspective, the Library of Congress only contains about 10 terabytes of text data. Payers like Anthem also 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. Anthem’s data science team is a leader in this arena and has developed highly specific algorithms based on 17,000 variables, giving you a clear, accurate picture of your employees’ health and predicting manageable, effective health care solutions.
The Role of Data in Health Plan Networks
Employers have a role to play in lowering employees’ health payments with value-based care. Many businesses are helping steer the drive toward value-based care through their health plans. The majority of Americans get their insurance through their employers, so your decisions matter.
One of the primary ways employers weigh in on value-based care is through the networks they offer employees within their health plans. Forbes reports that nearly 40 percent of businesses have some kind of value-based benefit in their offerings. Many also encourage employees to visit doctors within accountable care organizations or high-performance networks.
With the push to apply the data health care providers already gather, physicians and health care facilities are reporting their metrics for outcomes, quality, readmissions and general measurements based on their performance. Employers and health insurers develop value-based health plans with these facilities by negotiating contracts and cultivating networks that drive employees to high-performing providers — all with the aim of giving employees high-quality health care at a lower cost.
How Data Can Improve Employee Health
Developing a high-quality network for your employees is just the first step. You can take data even further — with the help of a third party. There are two main types of data to keep in mind: predictive analytics and prescriptive analytics. Predictive analytics gather information, evaluate trends and forecast what’s likely to happen next. Prescriptive analytics go one step further and use the trends and expectations to recommend actions. Your employee data is fed into a larger database, collecting information from health claims, wellness programs and other sources. A third party like Anthem analyzes all those data points to identify gaps in care or risks for chronic diseases and make personalized recommendations to improve health.
An example of this in action is how Anthem analyzes patient histories to uncover patterns that lead to the development of chronic illnesses like heart disease or diabetes. When your employees’ claims are added into the mix, Anthem’s data team can identify those who may be at risk and alert them through preselected channels to encourage early intervention, with the ultimate goal of avoiding costly treatments down the road.
Reducing hospital admissions and emergency room visits is another goal that prescriptive analytics helps address. Anthem’s data set can identify members who are likely to have an avoidable trip to the ER. Those members receive education about appropriate sites to receive immediate care. This has led to a decrease of more than 11 percent in avoidable ER visits, with a possible savings of $19 per engaged member per month. Anthem’s data analytics team also has targeted programs for specific conditions such as substance abuse, neonatal intensive care unit (NICU) admissions or chemotherapy side effects, all of which can lead to long hospital admissions. By identifying those at highest risk, Anthem is able to reach out with education or specific recommendations to help prevent hospitalization or reduce the length of stay. In this way, Anthem has seen savings of over $400 per engaged member per month not only for its NICU outreach but also for its work reducing cancer patient hospital admissions.
The goal of applying prescriptive analytics is to draw on all the information available to you to provide early interventions and deliver the right services at the right time to your employees. With unprecedented levels of measurement in health care available, employers, insurers and health care providers can work together to make sure your workforce gets better care at a lower cost. Don’t wait until employees make a trip to the hospital to let data drive care. Working with Anthem to create customized, insightful health care solutions supports your business by controlling costs and developing a healthier workforce.
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