How an analytics solution for integrating clinical and claims-based data unlocked actionable insights for Kaiser Permanente

Healthcare analytics is a white-hot area of innovation, but too often such solutions merely automate existing processes without improving them. 

During a December Becker's Hospital Review webinar sponsored by MedeAnalytics, health analytics leaders discussed challenges facing payers and health plans, along with analytics tools that can help them solve these problems. Panelists were:

  • Andy Dé, vice president of marketing, MedeAnalytics
  • Kathryn Elder, senior consultant, Kaiser Permanente
  • David Holt, director of underwriting, Kaiser Permanente

Three key takeaways were:

1.) Payers and health plans are dealing with challenges that put revenues at risk. Those challenges include rising medical and pharmacy costs, declining commercial membership, changing healthcare priorities that require access to real-time insights, a focus on value-based programs and provider network management. Current approaches, such as analyzing claims data, do not provide sufficient data to address these challenges because the data is retrospective. "Health plans are under more pressure ... and need access to real-time actionable insights," Mr. Dé said.

2.) Solutions that leverage AI and analytics enable organizations to tackle these challenges proactively. When analytics and AI capabilities are packaged in an integrated software solution such as those MedeAnalytics offers, they can reduce payers' dependency on claims processors to comb through static spreadsheets and dashboards that contain differing versions of the truth. 

"Payers need self-service analytics to empower their employer clientele and their brokers to understand, mitigate and explain costs at the executive and user levels," Mr. Dé said. He added that because of the consolidation of the provider market, health plans are no longer able to dictate the terms of payment arrangements with providers and need to be armed with competitive data to structure contracts beneficial to all sides. 

3.) The key objective of blending AI and analytics is to integrate clinical and claims data for improved decision-making. Such integration augments visibility into some of the factors driving healthcare cost trends that have the greatest impact on payers. "Understanding the correlation between the clinical side and the claims side is the piece we had been searching for," Ms. Elder said. Kaiser Permanente Analytic Insights, the organization's self-service analytics platform, delivering actionable insights to its customers, brokers, executives, and clinicians, powered by MedeAnalytics' solutions was the answer. "It opens up the door to articulating the value of integrated care through data," Ms. Elder said.

In the webinar, Kaiser Permanente articulated seven (7) use cases summarized below:

  1. Integrating clinical and financial data via MedeAnalytics enables Kaiser Permanente to not only identify smokers but also quantify the cost and utilization of a smoker vs. non-smoker to help a customer implement a smoke free campus policy. 
  2. Similarly, the ability to identify adult BMI prevalence rates and costs and stratify patient populations into risk based segments or cohorts helped drive lifestyle risk management strategies based on actionable data and insights.
  3. Observation of higher ER visit rates and lower clinical engagement rates such as preventive care and COVID-19 vaccination rates helped target on-site education on preventive care and alternative ways to access care, impacting productivity for a mid-sized employer whose business model was based on commissioned sales and service.
  4. Analysis of pharmacy data via MedeAnalytics solutions helped demonstrate Kaiser Permanente’s rapid adoption and ability to scale a generic lower cost generic equivalent/biosimilar drug observing average savings of $ 4000 per script, across all regions.
  5. Analysis of Opioid utilization at a customer identified increases in opioid utilization around a large customer population as well as the network physician allowing for contracted physician education and collaboration with KP physicians.
  6. Given the needs of the underwriting department to ensure rate sufficiency for the upcoming contract period, proactively identifying high-cost claimants who are the largest driver of annual claims variation is critical. MedeAnalytics help lower ad-hoc report turn-around-times (TAT) from weeks to minutes. 
  7. Combining claims data with some clinical data (biometric, cancer screenings, chronic condition prevalence data) and comparing against Kaiser Permanente regional and industry benchmarks, enabled its Account Management, Underwriting and Physician teams select Brokers and customer with self-service analytics capabilities, contributing to higher efficiencies, customer satisfaction and retention. 

Kaiser Permanente saw a 75% reduction in turn-around-times (TAT) on ad-hoc reports form employers and brokers, an 80% reduction in TAT on ad-hoc reports for healthcare analysis and reporting and a 6 month payback on its investment in MedeAnalytics solutions.

By combining the scale of Kaiser' Permanente’s clinical and claims data, which previously resided in silos, and the advanced analytic capabilities of MedeAnalytics solutions, Kaiser Permanente has unequivocally demonstrated the ability to solve some of healthcare's toughest challenges through well-matched partnerships. "Because of MedeAnalytics, I have group-specific data at my fingertips, available in real time, and we are able to focus on actionable, accurate insights in order to serve our business needs," Mr. Holt said.

To view the webinar, click here.

To register for upcoming webinars, click here.

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