The Quest for Healthcare Quality Begins with Analytics
When we talk about healthcare quality, we have to start with data. So it was fitting that a HLTH VRTL 2020 session devoted to healthcare quality and value kicked off with a presentation from the Jean Drouin, MD, CEO of Clarify Health, a data and analytics company. Clarify leverages disparate large data sets to enable profiling physician and facility providers in the dimensions of quality and efficiency of care with statistical credibility. As in clinical medicine, the first step is always the diagnosis! When provider groups can identify performance issues, they can take steps to improve quality. When health plans can differentiate providers based on quality and value, they can build better networks.
Employers can act on analytics as well. We heard from leaders at two large self-funded employers that have actively pursued solutions to address the underlying variation in quality and cost in their baseline networks. Cummins, an international manufacturer, used a unique analytic tool to assess provider value in their core mid-western location. Largely focusing on elective surgical procedures, they found striking variation in both cost and quality performance. Interestingly, there was no consistent correlation between quality and cost performance. While disturbing, this fact implies opportunity, as surgeons and associated facilities delivering good outcomes were often of average or even below-average cost. Cummins is implementing a strategy that will use network design to drive member choice of the higher-value providers.
PepsiCo, an international food manufacturer, is a bit further down the path to unlock network value. After conducting a similar analysis that identified the opportunity, they worked upstream to achieve the desired outcome. Instead of focusing on the surgical specialists, the company contracted with three primary-care-based medical groups to both drive quality, evidence-based primary care but also, crucially, to control referral pathways. Armed with data on quality and cost outcomes, primary care providers could make informed choices for those members requiring elective procedures and other related services. Since launching in 2019, this initiative has produced impressive results.
The second annual HLTH conference on innovation in healthcare took place in October, and Mercer again sponsored a series of sessions for employers. We encourage you to explore these 30-minute sessions. They begin with a short introduction from an industry CEO, followed by an interactive discussion between two to three employers.