This is what Heather Lavoie, president and CEO of Geneia, a population health analytics company, has been hearing from providers:

• The unprecedented drop in service volume during the pandemic has led to staggering financial losses and slimmer operating margins.

• They lack of a clear line of sight into revenue opportunities. Providers do not even know what they are missing.

• They don't have timely and actionable information to respond to quality and coding performance opportunities.

• Missing is a centralized way to identify, prioritize and reach out to patients with the greatest opportunity for impact.

Lavoie says this is where a thorough understanding of analytics comes into play. And she's ready to share her expert tips. Healthcare IT News sat down with the CEO to get those tips and much more, to help providers make the most of their work.

Q. You contend that healthcare provider organizations are leaving pretty easy health plan money on the table, and that analytics can help. How can analytics help hospitals and health systems understand who has gaps in care to target outreach for services and revenue capture?

A. Most population health analytics companies can use their data to identify patients who are missing preventive screenings and have gaps in care tied to chronic conditions such as diabetes and hypertension. For example, October, which is breast cancer awareness month, is a fitting time to identify women whose mammograms already are overdue or are due in the next three months.

Care gap data helps providers to:

• Evaluate measures such as mammography against industry or contract targets at the provider level.

• Identify cohorts of patients who have open gaps in care.

• Reach out to members, one to many times, to schedule primary care visits and referrals to specialty practices to close gaps in care.

The availability of predictive analytics enables healthcare organizations to go one step further. Predictive analytics identifying the patients at high risk for emergency department usage, a hospitalization or readmission can be integrated with lists of patients with open care gaps to create prioritized lists of patients for engagement. 

Likewise, models predicting which patients will become high-cost in the next 12 months can be used in the same way.

Q. On another note, how can analytics help provider organizations monitor leakage outside of the community and draw patients back in for continuity?

A. A 2019 report found the cost of failing to track and manage network leakage or out-migration is high:

• 43% are losing more than 10% of annual revenue.

• 19% are losing more than 20%.

•  23% don't know or don't track results.

Many providers in risk- and value-based care contracts have access to administrative claims data. Claims data reveals when patients' use of out-of-network specialists, labs, urgent care and hospitals. Patient-level data shows which patients are accessing services and which services they are using.

Provider organizations are able to use this claims data in two ways:

1. To improve care coordination. Practices can seek lab tests and the results of any services performed to complete the clinical profile.

2. To prioritize outreach to patients accessing care outside of the community. The savviest ones seek first to understand why a patient is leaving the community for healthcare, and then to educate him or her about the availability of local healthcare resources as well as the importance of care coordination.

Q. How can analytics help hospitals and health systems capture the full value of existing quality programs by addressing low-hanging fruit, including missing and suspect coding?

A. Every commercial insurer offers a quality bonus program – even for those providers who are still operating in fee-for-service only. Despite the real incentives that are offered, many hospitals and providers leave money on the table by failing to leverage analytics to drive quality upwards. A typical quality bonus program offers additional money on a per-member/per-month basis for the commercial and Medicare members.

Quality bonus pay can be significant. A large independent primary care practice uses Geneia analytics to prioritize outreach to high-risk patients and identify areas for improved care coordination.

Last year, one health plan paid the practice $6 million in bonus payments for exceeding the goals in their value-based contract. Increasing rates of preventive care and cancer screenings, particularly in the pandemic, also is the right thing to do for patients.

Robust population health analytics will interpret data such as pharmacy and longitudinal data to flag patients with suspect or missing codes, offering the provider practice the opportunity to update patient documentation to get full recognition and the associated revenue. 

In other words, analytics, through the identification of suspect or missing codes, can help providers better align their compensation with their patient care effort.

Q. Finally, how can analytics help improve engagement to drive patient retention with low-touch digital tools?

A. In virtually every other industry besides healthcare, analytics are used to identify cohorts and target messaging to drive consumer behavior. Healthcare is at the beginning of the journey to use advanced analytics to segment patients into likeminded cohorts and personalize engagement messages.

Cohort-specific messaging and nudges help patients feel known by their providers, improving the effectiveness and likelihood the patient will do the desired action, such as schedule a mammogram. More sophisticated providers also are using patient communication preferences – phone call, email, texting – to improve engagement and retention.

Likewise, the timing of patient messages is critical. Reaching out to women about missed mammograms in October, which is breast cancer awareness month, enables providers to take advantage of widespread corporate messaging that reinforces the importance of breast cancer screenings.

A new prediabetes diagnosis is an opportune time to educate a patient about lifestyle tools and programs for mitigating the progression to diabetes.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.