Posted by: adelvecchio
Affordable Care Act, Big data, HITECH Act
I’m sure you’ve heard the expression “mind your Ps and Qs.” Now, I’m not asking you to mind your “pints and quarts” from where this old English pub expression is thought to have originated, but rather the Ps and Qs in aligning big data in healthcare.
The first set of Ps: Value-based care (i.e., outcomes-based rather than volume-based reimbursement) has created a use case for greater alignment between the provider, payer and plan for the betterment of the patient. But let’s not forget pharmaceutical and product manufacturers. As industry embraces pay-for-performance, there is a desire to demonstrate cost effectiveness and outcomes to achieve reimbursement. The alignment between these Ps theoretically will increase effective care, outcomes and satisfaction while reducing redundancy and ineffective treatment. These Ps will generate vast amounts of big data — defined by the three Vs: volume, velocity and variety. At Explorys, we will occasionally add veracity and value.
Data alone will not lead to this alignment. Here we need a second set of Ps: People, process and politics. The various stakeholders need to work at developing several joint processes that drive towards a common politically-attainable, appropriately and credibly-priced product. Perhaps in a value-based healthcare economy — price is another “p.” Examples I’ve seen that try to align the two sets of Ps include programs where pharmaceutical companies and payers come together to support disease management among diabetics, asthmatics and chronic pulmonary obstructive disease patients to supply otherwise expensive therapeutics and diagnostics, collect much needed patient reported outcomes and educate patients and providers.
Our data suggests that as many 10-15% of diabetics and perhaps 25% of hypertensive patients may have unrecognized diseases. These patients are not identifiable for intervention by providers in disease management programs until much later in their disease course and are not available for drug treatment, something that has been noted by pharmaceutical companies. Patients, providers, pharma and payers clearly have an interest in earlier recognition of illness. There is compelling data which suggests that delayed diagnoses lead to greater mortality, morbidity and associated health expenditures. A unified healthcare big data platform that aligns these Ps and respects the politics (i.e., data governance) is critical to successfully identifying these opportunities in real-time.
However, aligning these sets of Ps and a unified data platform is not easy and has been the crux of portions of the Affordable Care Act and interoperability standards promoted by meaningful use part of the HITECH provisions of the American Recovery and Reinvestment Act of early 2009. Promoting EHRs, programs such as accountable care organizations, shared savings programs, bundled care initiatives, patient centered medical homes and patient centered outcomes research institute is a start, but there is still a great deal of work that needs to be done to further this alignment.
If done well, what do we get if we mind our Ps? We get to mind our Qs: Quality and qost. Now, I cheated with the spelling of qost (i.e. cost) but you get the idea.