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A NEW DEAL FOR GOVERNMENT HEALTHCARE PAYERS

Rethinking delivery paradigms for healthcare customers

Overview


Government healthcare commissioners know that better data can help improve the quality and cost effectiveness of public healthcare. This has driven ever-increasing efforts to address the technical challenges of data collection, integration and analysis. But what quickly becomes clear is that better data on its own simply allows for better monitoring. Payers wanting to effect real change need to find ways to turn valuable data insights into the right provider actions.

READ MORE ABOUT THREE WAYS GOVERNMENT HEALTHCARE PAYERS CAN MAKE THE SHIFT [PDF]

Background

Many health administrations have made significant investments in health information systems and management but fallen short of using this data to directly activate quality improvements. In the UK for example, 96% of primary care practices now have digital records but this has not had a significant impact on quality.

Similarly, report card systems, like the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), have been shown to deliver no statistically significant improvements in quality.

Key Findings

To form the right foundation, government payers should be working on three key data priorities:

  1. Go raw: Direct access raw data gives payers the power to identify highly specific problems and opportunities. High level indicators are useful but without the raw data underpinning these, payers are unable to perform the more sophisticated analysis necessary to effect change.

  2. Go standard: Data points, definitions and formats need to be standardized across the health system. All too often, government payers grapple with incongruent data sets from different sources making useful integration or comparison impossible.

  3. Go transparent: Government payers should be transparent with the data they have and how it leads to the decisions they make. Data transparency, particularly around benchmarking, procurement, reimbursements, contract reallocations and other important decisions, will help payers build trust with providers.

Analysis

Data on its own doesn’t effect change. Improving healthcare quality relies on a laundry list of complex, coordinated actions and mechanisms, including process reengineering, engaging clinical staff, developing new tools and managing change.

Payers that want to activate improvements will need to collaborate closely with providers in building these actions and mechanisms. Doing this demands trust and open dialogue.

Recommendations

The goal for payers should be to develop a repository of raw, standardized data that is available (using comprehensive access controls) to all providers and health service researchers. This serves as a common record and an authority that informs public healthcare decisions.

With raw, standardized, transparent data frameworks in place, government healthcare payers can create greater trust and more effective collaboration with health providers. Within this framework, an open dialog can begin on data integrity and the role of data in improving quality and outcomes.