Healthcare - Seizing The Information Advantage

Topics: Healthcare IT Management | Health Information Governance

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How healthcare organizations can unlock value and insight from the information they hold.
A PwC report in conjunction with Iron Mountain


Executive Summary: A Focus On Healthcare

Data is the lifeblood of the healthcare economy. It is the driving force behind the industry’s transformation and is essential to achieving the triple aim of improved patient experience, improved population health, and reduced costs.

There is a clear need to unlock the value tied up in information, and many healthcare organizations are confident they have the capability to do so. However, our analysis shows that this confidence is largely misplaced. Close scrutiny of the 150 interviews that we conducted with senior leaders in the US healthcare industry shows that very few healthcare organizations are able to mine information to its full potential, and fewer still can realize the resulting benefits.

Our research also found that, in common with most other sectors, the majority of healthcare organizations are deficient in the required skills, technical capabilities and culture to truly gain the greatest advantage from their information. This is reflected in our first Information Value Index for healthcare which scores 55.8 out of an ideal 100.

Despite the deficiencies, pockets of good practice do exist. We have identified a small group of healthcare organizations that are the leaders in the field: the ‘information elite’. These organizations, which make up just 7% of our sample, have quickly worked out what it takes to deliver value from the information they hold. The rest of the healthcare industry can learn from the elite by taking heed of the good practice exhibited by these front runners with regard to their information governance; their culture of evidencebased decision making; the way that they balance managing information for both risk and value and their understanding of the need to employ and embed analysts, using fit for purpose tools, across the organization.

This paper outlines the findings of our study and highlights a number of key practical steps that healthcare organizations should adopt if they want to truly seize the information advantage.

The Information Conversation Has Shifted

The evolution from fee-for-service to payfor- performance and the rise in digital health have been two of the most important disruptors to healthcare organizations of all sizes. Many organizations have been agile and innovative in their response and the disruption, therefore, has been positive. Many others, however, have not responded so positively and risk being left behind.

During this period of disruption, the amount of health related data being generated has grown exponentially. Whether it be information from electronic patient records, health data from wireless, wearable devices or new imaging technologies, providers and payers are being swamped with data. This growth has created risks and opportunities that require significant change in organizational culture, governance, strategy and ways of working.

In the age of big data, the information conversation has shifted. Where once the key concern was information risk, discussions now embrace the idea that healthcare organizations must make the most of their information to improve patient outcomes, use resources more effectively and gain competitive advantage.

The quest for the information advantage is influencing strategic goals. There is now a growing awareness in the healthcare industry that failure to embrace the changes required to manage information for its value is no longer an option.

University Of Pittsburgh Medical Center, Insurance Services Division

UPMC is an integrated payer/provider system with over 2.7 million covered lives in its insurance products, 21 hospitals, and over 3,500 employed physicians. The payer/provider organization creates a perfect laboratory to learn with data. UPMC Health Plan undertook an exploration of readmission using big data modeling techniques and developed a conditional readmission model that produces a readmission risk prediction score that does not require any information from the index admission and is produced each month on every member. That score is available to the hospitals at the point of admission. Additional modeling uncovered optimal post-discharge clinical follow times. In conjunction with the provider system, UPMC blended a publically available readmission model that creates a readmission risk at the point of discharge with the conditional readmission model using machine learning techniques.

The blended model guides patient discharge activities. Additionally, routine physician reporting metrics now monitor the percent of discharges seen within the optimal post-discharge follow-up window. The impact has been a reduction in readmission rates (and thus costs) and an increase in optimal clinical follow-up post-discharge.

Source: Big Data Healthcare Analytics Forum

The Information Advantage What Is It?

So what is the information advantage and what are the core capabilities required to capitalize upon it? In essence, this is about effectively managing information – in new or novel ways – that can change how healthcare organizations interact with their key stakeholders, support new business models, predict customer/ patient behaviors, find opportunities to improve operating efficiencies and enhance patient experience.

This is about re-purposing data to create information, whether it is born electronic, in original paper form or digitized, and applying innovative processes and tools to analyze the data and share it with those who have the interpretive skills to convert insights to meaningful clinical and business decisions.

However, this is not easy. It requires new strategies and changes to traditional ways of working, investment in people, tools and technology and a vision with executive-level endorsement to drive acceptance and implementation.

Seizing the information advantage must be approached from a continued understanding of, and robust approach to, managing information risk. In our view, most organizations have two potentially conflicting priorities: the first is security to protect against data breaches and loss; the second is value extraction.

It is hard to get the balance right between protection from the damaging impacts of data losses or breaches and in being bold and sufficiently confident to embrace the opportunities and advantages that can be gained from utilizing health information in different ways. Striking this balance will become an increasingly pressing priority for organizations of all sizes.

With a core focus on understanding the extent to which the organizations are currently seizing the information advantage, PwC – in conjunction with Iron Mountain – surveyed 1,800 enterprise and mid-market organizations across Europe and North America. This paper focuses on the sample of 150 US based Healthcare organizations that took part in the study and reveals the healthcare industry still has a long way to go to fully seize the information advantage.

The information advantage allows healthcare organizations improve clinical outcomes, enhance patient experience, and lower cost through an ability to:

  • predict patient behavior and utilization patterns
  • segment populations based on individual needs and preferences
  • make effective decisions around treatment options
  • optimize utilization of assets and clinical programs
  • design ideal networks of providers for the population served.

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