Published on Jul 08, 2016
Total utilization and costs of care provide stakeholders with a view of a healthcare-related information across the continuum of care. Insights gained from this knowledge will help hospital care managers assist their physician partners to make better decisions about the care they are providing and it paves the way through the transition from volume to value while helping the medical staff and the organization build competencies to succeed in a value-driven marketplace.
HealthPartners is an integrated health system in Bloomington, Minnesota, that includes seven hospitals, dozens of primary care clinics and urgent care centers, and a health plan. Over the last 20 years, supported by grants from RWJF they've been working to develop an application that provides Total Cost of Care (TCOC) using administrative claims data to calculate a cost index and resource usage index. It's a simplistic explanation of the complex algorithm HealthPartners made public for other organizations to use, but essentially, two indices are used together (Total Cost Index - TCI and Resource Use Index - RUI) to give providers a more complete view of the care their patients are receiving. In 2012 the program was endorsed by the National Quality Forum (NQF).
For example, at Family Medical Group Northeast, a large practice in Portland, OR, all services its patients used are attributed to a primary care physician at the practice. Any time a patient visited an outpatient site, or an emergency department or had a medication order, that claim data was rolled up into a cost index that showed individual physicians and practices how they compared to their peers, both on costs paid by the payer, and resources utilized.
Using comparative cost data is not new. I recall a hospital client in Connecticut using APR-DRG severity adjusted data over a decade ago. Its purpose is simple...let the physician see how their practice compares against those of their peers caring for similar patient populations. And then, let the data speak for itself. It's a no-brainer.
Today the need for healthcare analytics is even greater as new payment models demand information on the total costs of care. Health system execs have shifted their attention from hospital specific data to the total cost of care across the continuum. It's no easy task but there are solutions that can facilitate data mining across multiple, disparate IT system. Consider harnessing analytics as a journey, not a destination - just like the preparations hospital execs are making to survive in the new era of reform.