The next natural progression for Healthcare analytics

In building out our services practice, we have made a lot of headway consulting for small and medium sized businesses in the healthcare industry. With the 2015 government mandate to put electronic medical records in the cloud and make patient information more accessible to the patients themselves, we at Bimotics have seen healthcare providers exploring cloud based analytics options. Now that these providers have found ways to store records in the cloud, they are looking for cost effective methods to leverage this data for reporting and analysis.

With data already in the cloud, healthcare providers are seeing that capital costs needed for more administrative services can be minimized as spending for technology infrastructure such as hardware and structure can be left to the those providing cloud services. Cloud technology also benefits the patients with greater access to their information--even from different specialists and hospitals. With these increased efficiencies and accessibilities, the tangible evidence of cloud’s benefits is speeding its adoption in the healthcare industry.  

Adoption for healthcare based cloud business intelligence and analytics is not without its challenges and obstacles, however. HIPPA compliance, for example,  requires stringent privacy rules and has very serious repercussions when requirements are compromised. There is also much concern surrounding security and data integrity. Solutions can be engineered to address these concerns and we will go into the details of these technical solutions in upcoming blog installments.

Cloud-based healthcare analytics is definitely coming, and coming sooner than some may think.  Given the mandate to place patient records in the cloud and the associated advances enabling holistic patient care, healthcare providers and patients alike will demand equally cost-effective and accessible reports of the services they give and receive.

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The value of HMO analytics

In our last blog, we discussed how cloud-based healthcare analytics is gaining traction as medical records increasingly migrate to the cloud and managers seek new insights into workflow, waste, and administrative processes. This time, we take a further look at some key analytics  that utilization and finance managers in medical clinics and HMOs are leveraging to generate superior reporting and analytical capabilities.  Here are 7 ways business intelligence can enable comprehensive analytical clarity to HMOs.

1. What is my membership per member per month (PMPM), versus cost?

This metric is equivalent to income vs. costs in most businesses. It indicates how well you are managing your cost of services and how well you are positioned to sustain or grow. PMPM can be measured against both income and cost.

2. Optimize the overall HMO organization efficiency

HMOs are based on a capitation payment model where a group of physicians are paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person uses medical services. Tracking and constantly measuring their costs and utilization is key to maintaining positive revenue.

3. Identify departments that are over utilized

By applying PMPM to a department or service, HMOs can compare their budgeted PMPM to their actual expenses. This helps them decide if their services are correctly balanced. Services that are not conducive to providing a fast diagnosis may not fit the capitation payment  model of HMOs.

4. Analyze usage trends to improve performance

Trend analysis of physician, pharmacy, laboratory, community program, hospitalization, and urgent care data allow HMOs to understand patterns and gain insights which in turn allow them to negotiate better rates or modify those patterns. Trend analysis helps managers to proactively  reduce costs and improve their businesses.

5. Monitor network allocation trends to drive customer satisfaction

By analyzing geographic and demographic information, HMOs can  provide a higher quality of services in the most cost effective way. Changing patient demographics can affect HMOs’ contract models, and it is important that they stay abreast of these changes with smart analytics.

6. Special program effectiveness

Special programs are key to HMO services.  For example, preventative programs can reduce inflated costs down the road.  Similarly, education programs can help patients respond to services better. Tracking these programs is key to understanding how they impact the HMO as well as which patients are benefiting the most and which still need to be targeted.

7. Physician, laboratory, pharmacy, radiology high quality of care metrics

Trend analysis can be applied to any department of the HMO. Following best practices that have been developed through careful BI analysis results in better services and increased cost effectiveness. For example, learning that a physician is prescribing all name brand medication vs. generics, realizing that hospital stays are extending beyond protocol, and determining that certain lab tests are not meaningful enough for a correct diagnostic are valuable insights. Monitoring trends help keep organizations knowledgeable as to what works well and what needs to be improved to boost efficiency and eliminate waste.