Using data and learning from variation

New horizons - 2013 health care industry report

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EY - Stephen Plume, MD, Professor of Surgery

As reimbursement models evolve to be based on outcomes, optimizing the usefulness of patient data can be a marked advantage in identifying variation, improving delivery of care and achieving quality goals.

One way to learn from variation is through collaboration with peer organizations. Collecting and sharing information can establish standards, illuminate differences in quality and spark improvements.

Considerations for your board and executive leaders

For all health care organizations

  • What opportunities does your organization have to pool data with peer organizations, standardize approaches to measurement, and visit and learn from your peers?
  • Do your clinical teams — physicians, nurses and other relevant clinicians and technicians — meet periodically to:
    • Discuss studies relevant to their clinical specialties and services?
    • Compare data and outcomes among members of your medical staff performing the same procedures?
    • Assess the efficacy of new procedures and devices?
    • Analyze data in an effort to continually redefine and update best practices for their procedures and specialties?

For providers

  • Is your organization effective in coordinating compliance and quality assurance functions to keep up with the linking of payments to patient outcomes — while ensuring that your policies and practices do not inadvertently violate any F&A regulations?
  • Does your organization conduct a robust self-assessment at least annually to evaluate its billing, coding and documentation efforts and, in particular, assess emerging trends?
  • Is your organization using innovative data analytics to identify areas of potential fraud for internal investigation?

EY - A conversation with Mary Grealy, JD, President, the Healthcare Leadership Council

For payers

  • Has your organization explored opportunities to support patient medical homes and other patient-centric delivery systems by sharing claims information with the health care providers in your market?
  • Has your organization tracked the costs of an episode of care, for commonly occurring diagnoses across all participating hospitals and providers, and compared your averages with those of other insurers in your marketplace?