Population health analytics

Health systems and health plans collaborating to tear down barriers

As the health care industry continues to focus on initiatives to achieve value-based care, many organizations are turning to analytics to help them improve patient outcomes and simultaneously reduce costs. Learn how collaboration across health plans and health systems can help take the power of analytics to the next level.

Unlocking the benefits of collaboration through analytics

​Many health systems and health plans are making value-based care a priority and are investing in population health analytics to enable their strategies. However, our research suggests that most health systems and health plans aren’t yet sufficiently focusing on effective analytic collaboration approaches that could unlock the synergistic benefits of combining the best of what each stakeholder has to offer.

The analytics approach of each stakeholder typically concentrates on their native proprietary data sets, which can constrain their ability to effectively collaborate and make it difficult to deliver a joint value proposition to the market generally—and to consumers specifically—of high-quality, affordable health care with a differentiated experience. This analytics issue is central to the health care industry’s ability to fix some of its fundamental challenges.

Health plans typically use claims and enrollment data to identify high-cost populations and inefficient care patterns at a macro level, while health systems tend to rely on clinical data to deliver patient-centered care. If these two stakeholders partner on analytics and shared data, they could be better equipped to understand resource use and practice patterns. They also could be more likely to develop innovative opportunities to improve outcomes and reduce total cost of care for patients as well as the overall population. Furthermore, as health plans and health systems share financial risk through value-based payment and governance models, their efforts could become better aligned to enable more mutually beneficial business models.

Advancing the US health care system

In today’s silo-based approach, patients sometimes receive follow-up care calls from both the health system and the health plan, which demonstrates the costly duplicative nature of our health care system. Neither group is best positioned to maximize the patient experience on its own. While claims data can give health plans a more comprehensive view of the patient, they often lack patient trust. Conversely, patients generally do trust their physicians, but health systems might not have access to the patient’s complete health history, let alone the economic and social conditions (e.g., income, housing, transportation, education, etc.) that impact their health.

As a result of our research and real-world client experience, we believe that improvements in shared analytics strategies between health plans and health systems can significantly advance the performance of the US health care system.

To work together on analytics, health plans and health systems may need to overcome competitive dynamics, human capital skill gaps, and technology constraints. Transforming long-time adversaries (purchasers of care versus providers of care) into collaborators can take time, effort, and trust. Moreover, the requirements for teamwork will likely become increasingly important if both sides are to win in a value-based care environment.

"We are not sharing enough data. Payers are not sharing enough with us; we do not share enough with them. We need to work better together and share data… If you share the costs, the solutions can be elegant and better."

—Chief innovation and technology strategist at a large health system

Accelerating the transition to value-based care

No single organization has all the data required to look at the patient and targeted population in a holistic manner. This can limit the ability of both the health plan that’s financing the care and the health system that’s providing the care, in addition to directly impacting the patient’s journey of care. To increase the potential for health care innovations, the constraint of limited data sharing will need to be broken so that all health care stakeholders have access to population health analytics.

A new construct between health plans and health systems might accelerate the necessary transformation to value-based care and population health. This includes new provider payment methodologies, clearly defined roles and responsibilities, evidence-based patient engagement approaches, workflow and collaboration tools, and an ability to align each organization’s investment in analytics to improve health care outcomes.

As they begin to partner, health plans and health systems should consider these two key steps:

  • Executive alignment. Successful collaborations between health plans and health systems can’t occur without first strategically aligning executive leadership teams, which often requires establishing trust. There needs to be trust that each side is going to help the other through challenges as well as successes. Enablers to this alignment can include innovative corporate structures, governance models, and financial commitments from both sides. Lessons learned include identifying a common set of mutually beneficial business goals, aiming for early wins, and providing support and education to each other.
  • Operational integration with an emphasis on technology and analytics. The synergistic potential between health plans and health systems requires an effective integration of data, analytics, and capabilities. When fully integrated, innovative care-management programs, digitally enabled clinical interventions, and physician and patient activation can drive high-quality, affordable care. Both stakeholders have compelling assets that, once combined, can result in new, actionable insights.

The existing approach for using analytics has obvious limitations. To dramatically improve cost and quality for health care consumers, health systems and health plans will need to collaborate on analytics. Each partnership may be unique. But to succeed in the new health care payment models and improve the health of their populations, health plans and health systems will need to find a way to more effectively share data and analytics.

To learn more about how analytics—along with industry collaboration—can improve patient outcomes and reduce costs, download the full report.

"Over the past several years, our CEO has a laid out a more focused vision on population health as a strategy for our health system."

—Executive director for population health at a large health system

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