Collecting data does not necessarily equal reduced costs, expert says
"So many people are doing analytics," said Karen Wolfe, president of Internet-based MedMetrics. "If you're really going to actualize or mobilize the findings, it needs to be linked to operations."
Wolfe said companies need tools to help them use data to drive down costs. For example, her company has a tool that helps identify quality medical providers in a particular area.
"People can go online, put in the specialty and ZIP code, pull up the providers in that region and rank them, so the analytics are behind the scenes," she said. "We're actively ranking providers based on their performance."
In that way, Wolfe says companies can find the best orthopedic surgeon or the best neurologist in a particular region. "That's what I mean about interpreting analytics and making them actionable."
Wolfe reviewed several tools that help companies use their analytics in operational processes. She outlined:
- Predictive intelligent profiling with alerts. Recipients are sent alerts when combined data elements indicate a particular claim portends risk. The information is imported daily to provide the earliest possible notification. "It doesn't make any sense if you wait until a claim is closed," Wolfe said. "Because we're monitoring the data on a daily basis, we can send alerts when those conditions occur. It's basic to medical management, claim management. People can't remember all the previous conditions in a claim, but the computer can."
- "Ask-the-data" query library. Users are given access to a system that allows them to compare a client's performance with others in the organization's book of business.
- Injury severity predictive score. Each claim's injury severity is scored based on its ICD-9 code(s) used to describe a patient's condition. Because diagnoses tend to accrue over the course of a claim, "we're monitoring those bills as they come in," Wolfe says. "When the ICD-9 code scores get to a [certain] point, we send an alert."
The tools are "easy," Wolfe says. Two send alerts to recipients and the others are work-in-process tools.
"My whole shtick is, let's make these analytics actionable," Wolfe says, "use them to empower and recharge managed care. It's doorknob simple."
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November 17, 2011
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