The Evolution of Payment Risk and Analytics

Bob Kelley, SVP, Center for Healthcare Analytics, and Larry Yuhasz, National Practice Leader, Truven Health Analytics.  As hospital systems pilot and implement at-risk contracts, a whole new analytical agenda needs to be developed.  Outcomes (both clinical and financial) need to measured and evaluated in a new light.  This session focuses on the creation of this analytical agenda.  An informatics process is highlighted which starts with the determination of specific insights and decisions that need to be made, followed by a “reverse-engineering” of the measures and data sources that need to be present to support those decisions in the first place.  Often times, the process leads to operational changes that need to be made in order to assure that specific measures can actually be achieved. This can include EMR data entry and templates, implementation and adaption of metadata disciplines, review of data models and warehouse structures, and the data element requirements of specific measures.  Special consideration is placed on the variation of data collected at the encounter level via clinical and administrative workstreams, and the complexities of dealing with temporal analytical requirements (e.g. real-time decision support vs. longitudinal and retrospective analytics).  Exploration of “big-data” methods are addressed, along with the importance of discerning between correlation and causality.