Regulatory Drivers and Quality Healthcare

The transition to a healthcare pay-for-performance model is driven by both regulatory and consumer factors. Let's dig into the key drivers and information needs that will be critical to harness and leverage to manage the challenges posed by this new model.

The key regulatory drivers include changes in Medicare reimbursement based on key Meaningful Use core measure. Accountable quality of care metrics also introduce not only clinical factors, but also patient experience and satisfaction surveys.

Meanwhile, healthcare consumers are demanding proof of cost effective, high quality care through coalitions like the Leapfrog group, and health plan payers are also developing their own quality evaluation measures such as HEDIS.

The metrics to be collected will span many areas across clinical and operational systems:

  • Clinical performance metrics, such as readmission statistics for 7, 30 and 90 day intervals
  • Prevalence of preventable hospital-acquired conditions
  • Compliance with protocols, order sets and documentation
  • Evaluation of outcomes against standard order sets
  • Patient satisfaction surveys

It will be critical to measure these factors internally so actions can be taken to improve them. Several capabilities beyond standard reporting functions can help, including:

  • Linked access to granular atomic data to identify key factors that may contribute to negative results. Doing so sooner rather than later can help forge a proactive change in course.
  • Defining sub-patient populations, as indicated by external measurement and reimbursement boards
  • Dynamic views on very specific cross-sections of the patient data across explicit time periods
  • Incorporating both qualitative and quantitative data

An analytics solution must have the right data foundation to move beyond simple retroactive reporting while leveraging the data to make improvements in care delivery.  Thinking strategically will help you far beyond simply maintaining reimbursements by identifying hidden opportunities to deliver patient-centric, accountable care.

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This post was originally published on July 18, 2012 on the Mastering Data Management Blog.