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Which side is up? Cubes and Risk Based Contracts

Which side is up? Cubes and Risk Based Contracts

Today’s healthcare delivery system is fascinated with ‘potential’. There is so much possibility. Isn’t there? Or are we getting a little ahead of ourselves in terms of the reality of the level of entrenchment in which hospital IT is mired? After all what is possible is totally dependent on data. Many key managers can’t or don’t know how to access cubes and they need access to data. This is because data provides understanding of what took place. Risk based models increase the pressure on data management. Risk models are an ‘in’ discussion for the value they can deliver to patients and the healthcare system overall but if your cube is only understood by IT or a few analysts in decision support are just ‘running reports’ for you, then risk based contracts and value based purchasing may not be a part of your lexicon in the near future. In fact, they should not be.

Is your success imminent? How easily can you assess risk? What procedures and populations are you willing to hedge your risk? Can you determine Primary Care Physicians who are aligned with incentives? Business intelligence is designed to help answer these questions and also steward your course to the achieving the goals of value delivery in your risk models. Dashboards which offer visualization of data on the pertinent care stages and updated direct and indirect costs associated with that care episode will help steward success in a risk model. But negotiating the risk model and knowing where to bare risk is key to your success. It’s time to see the upside. But the cube alone won’t get you there. Dashboards and a data model are needed to help end users see where there is opportunity. Then, your enterprise will be engaged in the KPIs most pertinent to your mission of delivering value by taking on risk.

Understanding data using cube technology is not foreign in hospitals at all. So why then are operating margins so slim, VBP reductions on Medicare revenue more prevalent then bonuses and fee for service more desirable than risk and bundled models?

It’s because data is scarce and the cube and its reporting are unavailable to end users in the operational setting. Cubes are important in analyzing and drilling into data but you can be left wondering, which side is up? Are outliers and variations in care processes and costs easily seen? If your end users (physicians included) lack the ability to easily visualize and interact with data in self-service fashion, then the business person hired to manage contracts, or grow margins, reduce costs, ensure compliance with Medicare’s VBP and direct the best practices for service line profitability and utilization, is hog tied. And the physician is not aware either. Imagine a physician analyzing their own implant usage and case contribution margins using a cube? Not happening.

Data is money. We mused about that in last week’s blog. KLAS addressed it in their BI perception report of 2013’s Data Management Symposium. I think we all agree. But just in case, CMS has addressed it in the primary goals of the recent VBP performance criteria. Is there anyone who believes they can just use Excel and some cube on lock down in the HIT room and succeed in the future of Medicare’s Value Based Purchasing? It’s getting complex out there- next year will include cost effectiveness of Medicare beneficiaries as well as the existing quality measures and 3 domains for clinical process, patient experience and mortality (outcomes). Now commercial insurers are getting into the mix….

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