Challenge #3: Using big data to improve quality and reduce costs
This is a third major challenge facing organizations. Only 12% of survey respondents say their organization is excelling in this area; the same percentage as in the 2016 survey. Forty six percent of 2017 survey respondents say they “have come a long way” in this area, but that they have a lot more work to do in this space. That’s up from 39% last year.
Shroff sees two main big data challenges. Although more healthcare data is being generated, the data is scattered across multiple entities—payers, providers, and patients. There is no such thing as a single “source of truth” for healthcare data.
“When patients jump between different health plans or providers, the data doesn’t follow the patient,” he says. “This, coupled with the lack of interoperability between entities, makes it difficult to harness data-driven insights.”
Secondly, most organizations lack the proper technology to manage or capitalize on the vast amount of information they possess. Healthcare data comes in various formats and sources—clinical data from EHRs, billing data from claims, patient enrollment or registration data, as well as self-reported patient data, Shroff says. To truly unlock the power of big data, organizations need a technology infrastructure that retrieves, stores, and analyzes various sources of data at scale.
Health plans and systems have the same challenge—getting access to the data that the other has. “A health system has access to the patient’s most in-depth clinical data, but it’s often limited to the specific episode of care that was provided at that system,” Shroff says. “When a patient visits other provider groups or hospitals, it’s the patient’s responsibility to recall the care that was provided at the other settings.” On the other hand, health plans are aware of every encounter that a patient has, regardless of which system they visit. However, their depth of knowledge is limited to the billing data sent from the systems. “Having both entities share their respective data would most likely result in better quality and cost savings, but organizations are simply not set up to do so in today’s world.”