Healthcare Is Demanding Clinical Predictive Analytics (and here are the things you should know)

Gartner* recently identified the biggest healthcare trends impacting or requiring new analytic capabilities. They broke each trend into six areas across care demands, new financial models, the changing role of the patient, the changing nature of care, reforms and regulations, and the impact of competition. Clinical predictive analytics has a role within each of these areas. While clinical predictive applications are not a panacea, they are a group of tools that are enabling clinicians, care providers, and hospital administrators with the power and foresight they need to help navigate the changing healthcare landscape. The following is a breakdown of how to leverage clinical predictive analytics across each major industry driver.

Healthcare Demands Redefined

The demographics and needs of the patient population are changing. Multiple trends are converging including an aging population, a rise in chronic disease, an increased demand for healthcare services, shifting demographics, and shifting populations. All of this is happening while providers are under increased pressure to reduce healthcare costs and diversify payment models.

How Clinical Predictive Analytics Help

Clinical predictive analytic applications deliver capabilities that align to these seismic shifts and provide the ability to:

  • Predict rising-risk and high-risk patients well before they show up at the hospital
  • Target avoidable admissions for patients with chronic conditions
  • Optimize length of stay
  • Drive market insights into changing demand and future investment

New Healthcare Financial Realities

Providers are dealing with two harsh financial realities: rising healthcare costs and the shift to value-based payment and incentive models. They are living with increasing prescriptive pricing and reimbursement controls that can result in significant penalties. Moreover, the patient population served and type of facility providing the service heavily influence these penalties and controls. As providers move from process to outcome measures, new areas of reporting and scrutiny are forcing the reallocation and recalibration of resources.

How Clinical Predictive Analytics Help

Clinical predictive analytic applications can help providers operate under new financial realities by delivering capabilities to:

  • Enable prevention over treatment
  • Prepare for value-based billing and reimbursement
  • Improve health outcomes by predicting and preventing nosocomial events and patient deterioration
  • Trend, in real time, quality benchmarks and measures
  • Predict utilization and Medicare spend per beneficiary costs

The Changing Role of the Patient

The patient is a consumer of healthcare now more than ever. There are diverse choices and changing expectations. Consumers are more engaged and demanding price transparency.

How Clinical Predictive Analytics Help

Predictive analytics help providers adapt to consumerism by providing insights to:

  • Drive health outcome improvements that increase patient satisfaction
  • Access real-time patient-level predictions to improve overall patient care and reduce the likelihood of infection and suffering
  • Ensure that patients are receiving care in the right environment and that interventions are tailored to the individual and his/her needs

The Changing Nature of Healthcare

Everything about the way we “do” healthcare is changing. Not only are we moving away from fee for service models to at risk models, we are also moving away from siloed to primary-team-based care. Consequently, we are seeing a rise in the role and importance of the care navigator. Consumers expect everyone on their care team to have access to information and that there is a fluid flow of that information across the continuum.

How Clinical Predictive Analytics Help

Clinical predictive analytics are key to survival in this changing landscape because they are fundamentally focused on improving health outcomes. They do this by delivering the capabilities to:

  • Prepare for and thrive in clinically integrated networks of care and coordination
  • Stop avoidable admissions and drive care activities into the most appropriate and cost effective setting
  • Predict ED and inpatient admissions to drive the better allocation of resources and intervention efforts

Government Reform and Regulation

Government-driven penalties and mandates aren’t stopping. In fact, the roll out of many value-based model components is accelerating. Add to this competition for limited resources along with political processes that are forcing changes to government payer programs. Providers are in many ways left to make sense of and live with the rules created by our government administrators.

How Clinical Predictive Analytics Help

Clinical predictive analytics go beyond compliance to:

  • Prevent avoidable readmissions and nosocomial events
  • Align providers to the overall movement toward value over fee-for-services
  • Provide the capabilities that will ensure compliance with mandates and qualities standards

The Growing Intensity of Competition

Changing payor strategies and blurring risk are increasing the number of players in the healthcare market and increasing competition. New partnerships are emerging between the private and public sectors, and payors and providers. And we are seeing a rise in the number of mega-provider institutions.

How Clinical Predictive Analytics Help

The growth of competition requires providers to become smarter about the communities they serve and future demand. This kind of predictive power has been in the hands of payors for a long time. Now providers can access the same kind of predictive engines to:

  • Forecast demand to drive more informed decision making around strategic investments, mergers, acquisitions, and divestitures
  • Benchmark comparisons and foresee areas of opportunity for market gains and further differentiation

Clinical predictive analytic solutions are helping providers address some of the biggest challenges and demands brought about by the changes to the healthcare ecosystem and new consumer and regulatory expectation. By giving providers the same power employed by other industries including consumer goods and advertising, patient health outcomes can be improved and hospital viability can be ensured.

* Transitioning to Value-Based Healthcare: Building Blocks for Effective Analytics 19 March 2015 ID:G00273137