As more patient data becomes available through the rapid adoption of electronic health records and regulations for treating these patients grow as part of the Affordable Care Act, healthcare providers are increasingly turning to business intelligence (BI) software to help them make evidence-based decisions across the clinical, operational and financial spectrum.
More than just helping hospitals produce visually appealing clinical reports to satisfy meaningful use and accreditation requirements, healthcare BI is providing data to help them trim costs while also improving patient satisfaction. With healthcare costs and the volume of patients on the rise, providers are feeling growing pressure to reduce expenditures across the board without sacrificing the quality of care.
This is a challenging directive to meet, but the obvious place to start cutting costs and increasing revenue for these organizations is by taking a deeper look at finances. This is especially true as the market shifts toward an accountable care organization (ACO) model and pay-for-performance initiatives that require many providers to provide proof of improved patient outcomes to receive full reimbursements.
Public and private health insurers are embracing this fee-for-value model, which pay providers based on quality versus services rendered and essentially give them a budget for treating patients that they must work within. This changing healthcare landscape is why financial analytics is still the top reason organizations are choosing to invest in healthcare BI.
This segment dominated the healthcare BI platform in 2014, accounting for $532 million in revenue, according to a March report published by Transparency Market Research. While it might not generate as much buzz as more advanced clinical analytics – the segment expected to grow the fastest over the next few years – using BI for financial analysis can be vital for successfully navigating the shifting terrain around insurance payment programs and keeping finances on an even keel. Here are three ways how:
- Reducing penalties. Hospitals operating under pay-for-performance systems through Medicare and Medicaid have been able to cut penalties for preventable readmissions through BI reporting tools and reports that motivate doctors to deliver high quality care on a more consistent basis. BI allows hospitals to track patients from the moment they are admitted to the hospital to treatment and discharge. Not only does this help ensure that they receive optimal care at every stage and reduce the expense of return visits, but it also helps identify what’s working and what’s not, so administrators can make smarter decisions about how to allocate their budgets.
- Keeping cash flowing. Administrators can use BI tools to help them create an accurate cash flow model that takes into account the amount of time necessary to process an insurance claim, discounts given to a particular insurance company and the amount of money being spent to care for patients. This is critical since many facilities incur expenses up front that they may not receive adequate payment for until the insurer pays the remainder of the claim.
- Anticipating patient needs. A growing number of providers are discovering the benefit of using BI to track trends within their hospitals that allow them to predict costs associated with meeting patient needs. For example, such analysis might reveal how many patients with broken arms are treated each fall during football season and allow the hospital to plan for the number of casts and pain pills it will need to order. Data like this could also be used to justify the cost of purchasing new medical equipment for a hospital.
As the standards for paying providers continue to evolve and hospitals look to rein in costs, more providers are discovering how they can use BI to boost their bottom line. Learn how to get started implementing a BI system that will support this data analysis in our white paper.