Topping the list is a movement away from traditional analytics that are focused solely on claims, clinical or financial data to a more 360-degree view of the patient enabled through behavioral analytics. To achieve this view, healthcare providers and payers will actively seek out new forms of data, such as geographic, income levels, socioeconomic data and other demographic information. They will also rely on population-based data about the effectiveness of different care plans and incentives. All of this data will be combined to deliver a more complete picture of who the patients are and the traits others like them share. Greater emphasis will also need to be placed on attitudinal information gathered from non-traditional sources.
"Recent events such as the Brexit vote in the U.K. and the Presidential election in the U.S., demonstrate that the use of big data in predictive analytics still has some maturing to do," said Lalithya Yerramilli, vice president of analytics at SCIO. "In both cases those performing the analysis had big data at their disposal yet they still got the outcomes wrong because they weren't able to take attitudes and the things people weren't saying into account. When it comes to getting into the psyche of individuals or populations to understand what concerns and motivates them, you need to be able to read between the lines as well as reading what's in front of you."
A clear example comes from the recent U.S. election. There was talk prior to the election about Donald Trump's "hidden voters" – those who would not admit publicly to supporting the candidate for a variety of reasons but planned to vote for him. It turned out the talk, which was based on information gathered through social media, personal conversations and other non-measurable means, was more accurate in forecasting the outcome than the formal big data.
"It shows the impact attitudes can have on actions," Yerramilli said. "You won't find data on attitudes in the electronic health records (EHR), or procedure codes, or claims data, or even socioeconomic data on its own. But events such as these clearly demonstrate the need we in healthcare have to begin capturing those non-traditional data points more effectively so we can understand our audiences better, which will help us learn how to drive them toward the desired outcomes."
This broader and deeper view will enable providers and payers to recommend care and develop programs that have a higher likelihood of having a positive impact. SCIO views this greater understanding of patient needs and motivations as being the key to succeeding in a value-based healthcare environment.
Insights as a Service
As behavioral, predictive, prescriptive and other types of advanced analytics demonstrate their ability to improve outcomes significantly, healthcare organizations will find it increasingly difficult to keep up with the demand using internal resources. Additionally, two-thirds of information workers overall in the U.S. are not convinced they are using current dashboards effectively according to Forrester. This need for more and better use of analytics, especially among healthcare organizations taking on additional risk, will accelerate the growth of insights-as-a-service, i.e., working with an outside business partner to transform data into actionable insights that result in measurable outcome improvements. Because of the complex nature of healthcare data, healthcare organizations will seek to form long-term partnerships that enable understanding to improve over time rather than one-off requests for analytics. Healthcare organizations will be able to co-source or completely outsource insights-as-a service according to their business requirements, while "as-a-service" flexibility allows them to ramp up or scale down quickly as-needed.
Fraud, Waste & Abuse of Opioids
Stopping fraud, waste, and abuse (FWA) of opioids and other prescription medications will grow even more important for providers, payers and life sciences companies in 2017, SCIO predicts. Opioid abuse in America has reached epidemic proportions according to the Centers for Disease Control and Prevention (CDC). Drug overdoses led to more than 47,000 deaths in 2014, the latest year for which data is available, placing it well ahead of cars and guns. Greater national media coverage will be a driver of the increased interest, along with the need to reduce the skyrocketing cost of prescription medications. Here again analytics will play a key role, replacing manual inspection of spreadsheets and other reports as an important tool in stemming the proliferation of FWA perpetrated by consumers, providers and pharmacies. The ability of analytics to prioritize the most significant cases with the highest likelihood of FWA while eliminating false positives will help the healthcare industry, various watchdog groups and law enforcement crack down on abuses of the system as never before. Capturing attitudinal data at the macro level will help spot developing patterns and trends in opioid abuse as well as providing insights into education and treatment programs that will be more effective at reversing the growth.
Big Data & Patient Personas
Another trend SCIO expects to take hold in 2017 is the use of big data analytics for the development of patient personas and other tools that will help target care more precisely. The use of personas – representative models of a segment of a population – have become popular in other industries. For example, consumer packaged goods companies use them to determine their retail display mixes based on geography, demographic, socioeconomic and other data. The gathering of population health management data by healthcare organizations over the last few years has now reached a point where there is sufficient data to begin developing reliable personas for most of the population. This information will not only be valuable to providers as they consider treatment, but also to payers as they determine how best to communicate with members and encourage healthier lifestyles. In addition, life sciences organizations will be able to use these personas to demonstrate why providers should prescribe specific medications or medical devices based on the makeup of their patient panels and the proven efficacy of the products within those personas. By overlaying macro social trends on top of the personas, healthcare and life sciences organizations can develop an even more precise picture of who these populations are and what motivates them.
Payer & Provider Collaboration
One final macro trend SCIO is predicting for 2017 is a significant increase in collaboration between payers and providers. Although the overall future direction of healthcare is uncertain, the concepts of value-based care and shared risk/accountability have proven popular on both sides of the political aisle. As a result, there is a high likelihood that U.S. healthcare will continue down this path over the next few years, tying payers and providers to each other's success. Sharing data and analytics capabilities will help both sides become smarter while reducing the individual cost either must bear. Life sciences organizations may also look to increase collaboration with payers and providers, creating a powerful triumvirate that enables better decision-making as well as better care that leads to a healthier America.
"Even in ordinary times there is some risk in making predictions," said Rose Higgins, president, North America of SCIO. "This year, with all the unknowns and mixed signals, it really becomes anyone's guess as to what will happen. Still, there are certain fundamentals that must takes place if we are to move ahead and continue to lead the world in the quality of care while bringing the cost of care under control. The capabilities and the desire already exist. It's now a matter of seeing the urgency and understanding the ways behavioral analytics and these other technologies can contribute to achieving industry as well as individual organizational goals."
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About SCIO Health Analytics
Based in West Hartford, Connecticut, SCIO Health Analytics is a leading health analytics solution and services company. It serves healthcare organizations across the continuum including over 20 provider groups and 30 health plans representing more than 90 million members, four of the top six PBMs, and clients in 30 countries for 8 of the top 15 global pharmaceutical companies. SCIO provides predictive analytic solutions and services that transform data into actionable insights, helping healthcare organizations create the understanding that drives change through care, network and reimbursement optimization as well as commercial effectiveness. SCIO's insights as a service approach supports the shift to value-based care, solving healthcare problems simply and efficiently. Visit SCIO's new website for up to date information on their product and solution offerings: www.sciohealthanalytics.com
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SOURCE SCIO Health Analytics