Gain insight from 'longitudinal record'

Using analytics to achieve value-based care in rural areas [Special Report]

By Brian Eastwood

In the past, healthcare providers could survive by simply reacting to the patients who walk through the door. In a fee-for-service world, they could even thrive that way. However, as payers and providers continue the shift to value-based care, it becomes increasingly important to reach out to those patients to prevent them from coming through the door in the first place.  

"The entire conversation in our healthcare system has to change," said Lynn Barr, chief transformation officer with the National Rural Accountable Care Organization (NRACO). "How do we protect the people in our town?"

It starts with knowing who to reach out to. While large facilities such as Catholic Health Initiatives can assess data across locations in 17 states to identify and target its at-risk population, smaller hospitals lack that luxury. In any other industry, you'd be hard-pressed to find a $10 million business without a dedicated analyst, Barr said, but that's not the case in healthcare.  

Healthcare IT is admittedly "underdeveloped" when it comes to managing complex care patients with behavioral or mental health conditions or multiple co-morbidities, Barr said. To help facilities serving these types of patients, the NRACO brings together Medicare claims data and other information from disparate providers in a single data warehouse.

It's not predictive analytics, and it's not health information exchange, but it does mean that member providers "have for the first time a true longitudinal record of their patients," Barr said. For example, one community, serving about 5,000 patients, discovered that 212 Medicare patients had been to 75 separate facilities in a 24-month span.

"Part of it is not knowing that you have a problem," Barr said.

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