Predictive Analytics: Building blocks for effective value-based care

Predictive Analytics: Building blocks for effective value-based care

Gartner’s Industry Driver

Healthcare Demands Redefined

  • An aging population, a rise in chronic disease, increasing demand for healthcare, differing demographics, increasing demand, shifting populations, increasing pressure to reduce healthcare costs, diversification of payment models

New Healthcare Financial Realities

  • Rising healthcare costs; shift to value-based payment and incentive models; increasingly prescriptive pricing and reimbursement controls, move from process to outcome measures

The Changing Role of the Patient

  • Consumer empowerment, more diverse choices, changing expectations, more engagement, and price transparency

The Changing Nature of Healthcare

  • Shift from siloed care to primary-team-based, emergence of the care navigator, use of sophisticated analytics for evidence-based diagnosis and therapeutics, consumer engagement

Government Reform and Regulation

  • Competition for limited resources and political processes that force change to government payer programs

The Growing Intensity of Competition

  • Changing payer strategies and blurring risk; new partnerships between private/public, payer/provider; rise of the mega-provider institutions

Predictive Analytic Application

Healthcare Demands Redefined

  • Population health predictions to address rising-risk and high-risk patients
  • Predictions targeting avoidable admissions for patients with chronic conditions
  • Predictions to optimize length of stay
  • Market insights into future demand

New Healthcare Financial Realities

  • Enablement of prevention over treatment
  • Preparation for value-based billing and reimbursement
  • Predictions to improve health outcomes
  • Real-time trending for quality benchmarks including PQI, PSI, IQI, and NQI measures
  • Utilization analytics and Medicare spend per beneficiary forecasts

The Changing Role of the Patient

  • Health outcome improvements that increase patient satisfaction
  • Real-time capabilities to drive preventions and improve overall patient care

The Changing Nature of Healthcare

  • Preparation for clinically integrated networks of care and coordination
  • Predictions that help address avoidable admissions and drive care activities into the most appropriate and cost effective setting
  • ER predictions including 30-day, high-utilizer, and unreimbursed care

Government Reform and Regulation

  • Predictions to prevent avoidable readmissions and hospital acquired conditions/illnesses
  • Capabilities to ensure compliance with current mandates and quality standards
  • Alignment to overall movement toward value over fee-for-service

The Growing Intensity of Competition

  • Forecasting that enables more informed decision making around mergers, acquisitions, and divestitures
  • Benchmark comparisons and predictions to drive market gains and differentiation
By Jvion Health