A Healthier System
Health Data Essentials delivers quality of care insight with SAS®
As part of the sweeping health care reform law in the United States, the Patient Protection and Affordable Care Act encompasses many provisions, including a series of quality initiatives aimed at measuring, tracking and improving the quality of care delivered by privately operated Medicare Advantage plans. Based on their ability to improve the quality of care delivered to their members, health plans will have the opportunity to obtain quality bonuses. To help US health plans meet the federal government’s quality of care targets, as well as qualify for Medicare incentives, Health Data Essentials – a consultancy providing analytical services, such as quality measurement, financial modeling and revenue management – is using SAS Business Analytics to help clients track their performance against quality of care metrics.
"The application we built is in response to the health reform legislation," explains Richard Lieberman, CEO, Health Data Essentials. "Congress came up with a five-star quality rating system. If a plan gets three, four or five stars they will get additional bonus payments for each of the members they have enrolled."
And with $5 billion in funds available annually, it behooves health plans to rally around the government's quality measurement program.
Enhancing the patient experience
"You can't get everyone; you just have to reach a reasonable threshold," Lieberman says. "In the case of mammograms, the government wants health plans to reach an 82 percent compliance rate, which would give a plan a five-star rating for that metric. To receive incentive payments in 2012, plans need to achieve at least a three-star rating as an average on all of their measures."
Lieberman says the government's program will have a positive effect on ensuring providers are delivering the right kind of preventative care, instead of only delivering episodic specialty care. The incentives aid health plans in changing the behavior of providers and patients by encouraging patients to schedule preventative screenings.
By gathering claims data, survey data and medical record review data, Lieberman's team is
"An underlying premise of the system is that if you're going to get in front of doctors to try and impact how they practice medicine or in front of a patient to impact their care decisions, you have to reach them in one go because you don't get that many chances for interaction. So we built a complete medical management platform into the system that uses predictive analytics to identify things such as avoidable hospitalizations and emergency room encounters. It also helps to achieve cost savings because if you do preventative care better, costs go down."
Mobile health insight
“They can look at preventative measures that the patient might need, as well as patient utilization of services that may not be in the doctor’s medical records – they can see more of the patient’s history by looking across the providers that the member has seen in the past.”
In the future, the consulting firm plans to add more predictive analytics to the system to forecast potential high-cost patient cases, with outcome variables like the risk of future hospitalization. Using a regression model, the system will rank members by their probability scores. Using predictive analytics will help health plans, for example, reach out to female members who have a low probability of proactively scheduling their own examinations, based on their prior care histories.
“SAS is extremely valuable for extremely complicated heath care analysis,” concludes Lieberman. “It requires superior data management capabilities and SAS’ ability to do procedural language programming is essential. There are significant technical advantages to using SAS for this sort of work – we would not be this far in such a short amount of time without using SAS.”
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Health Data Essentials
To help US health plans meet the federal government's quality of care targets, as well as qualify for Medicare incentives, Health Data Essentials' clients needed a system to track their performance against quality of care metrics.
SAS Business Analytics
“"There are significant technical advantages to using SAS for this sort of work – we would not be this far in such a short amount of time without using SAS."”