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Data Analytics and Visualization in Health Care
Module 1: Introduction to Health Care Summary
Stakeholders
● Stakeholders in the health care delivery system include consumers, providers, payers, employers, and the government. ● Stakeholders influence the delivery system differently: ○ Consumers make purchase choices. ○ Providers make health care decisions for consumers. ○ Employers/Governments make health care benefit and payment decisions. ● Stakeholders use health care data differently: ○ Consumers are beginning to use data to assist with choices for cost and quality in their health care. ○ Providers are using health care data more to demonstrate the quality of their care; this is a shift from quantity to quality for payment. ○ Employers use data to decide on what and how much to include in health care coverage; and what they want to spend on it. ○ The government uses data to assist with payment schedules, but also to monitor quality and develop programs to improve outcomes.
Care Settings
● Multiple settings where care can be delivered: inpatient hospital, outpatient ambulatory, office, home, hospice, community care, long term care, self care. ● Different levels of care impact the relationship to data capture, reporting, and cost. ● The goal of health care is to deliver quality care in the most appropriate and cost effective setting. This is key in controlling cost of care. ○ More acute settings like hospital inpatient are the most costly. If care can be delivered safely and equally in a lower cost setting, such as outpatient, it does not diminish the quality of care, but it does make it more cost effective. ● We use health care data and standard code sets to help differentiate between the delivery settings, or “place of service”.
Additional Terms and Concepts
● Managed care coordinates the health care experience across functions (financing, insurance, providers, payers) to achieve greater efficiency with integration. ● Primary care: A role and a model. The physician can be the primary care provider (PCP); or gatekeeper. The PCP has the broadest knowledge of your health care needs. This base level of care focuses on wellness and disease avoidance.
● A single-payer system can define the benefits, payment schedules, and coverage criteria. It eliminates market competition. ● Administrative costs: The price to execute health care, the policies and communications associated with regulatory compliance, and the information technology systems to process membership and claims. ● Utilization: The quantity of health care services used. This becomes a factor in determining cost and quality. Use is represented by the data sets of diagnosis, procedure codes, and provider practice.
Financing
● Benefits : Services that an individual (consumer), can receive as part of their insurance coverage. ● Premium : Amount charged by the insurer to cover the anticipated level of risk for medical care. ● Cost sharing: Division between the part of the premium the employer pays and the part the individual pays. The individual shares the cost of the premium and a part of the actual cost of care in the form of deductible and copay. ○ Deductible: Amount the individual pays each year before the health insurance plan pays for the service. ○ Copay : Amount the individual pays each time they receive a service. ● Claim form: The primary method to describe a health care service for payment. Uses standard code sets to reflect where, how, and why the service was delivered. ● Payment for the service(s) is based on a combination of the individual's benefits, their cost share, their deductible, and the fee schedule for the provider. ● Health data on a claim form is also used for analysis of health care services to support health care research and decisions in a broader perspective.
Public Health
● Public health focuses on protecting and improving the health of communities; of entire populations as opposed to the individual. ● For example, public health looks at the impact of the environment and wide spread communicable disease and develops broad communication and prevention programs.
Research and Regulatory
● Regulatory entities provide oversight, regulation, and strategic direction of health care. ● Example are CMS, ONC, and AHRQ. ● Core goals for these entities are patient safety, quality of care, and cost effectiveness. ● Methods that might be used by these entities to achieve their goals include: ○ Quality through the use of best practice. ○ Consistency through the development of standards of care. ○ Cost efficiencies through the use of technology.
Value Based Reimbursement
● An alternative payment methodology that drives quality and cost efficient care. Payment is tied to performance-related quality measures and works in two ways: ○ Reduced payments for failure to report the data (penalty). ○ Bonus payments when quality measures are implemented and met (reward). ● The patient experience is also a key factor in value based reimbursement. Surveys like CAHPS focus on aspects of care that reflect high quality (communication with doctors, coordination of care, understanding medication instructions).
Demographics and Population Health
● Data plays a role in understanding health care trends, utilization, and social and demographic impacts. Demographics is the study of specific populations. Population health data is information related to the health outcomes of specific groups of people. ○ The composition of populations can change over time. ○ Birth and death rates can impact population composition; for example low birth rate and low death rate creates longevity in the population. ○ Changing composition can alter the amount and types of services needed. ○ Demographic data is used to develop relevant treatment plans that incorporate race and ethnicity as there is variation in how specific populations respond to medical treatments. ● These broad measures of population health are used to change how health care is delivered and the treatment programs. ● Data associated with demographics: morbidity, mortality, activities of daily living, life expectancy.
Consumerism and Personalized Medicine
● Health care consumerism shifts the economic purchasing power from the employer to the individual. Personal choice and availability of data can influence selecting health care (what you value, what data you use).
Emerging Trends
● Strategies that improve the quality, access, and affordability of care. ○ Interdisciplinary teams of providers that coordinate care. ○ Technology that allows more intense procedures to be performed at alternate, lower cost settings. ○ Electronic health records that provide a way to collect, store, and share data, as well as reduce medical errors. ○ E-health and M-health supports health care delivery through secure portals and mobile apps. ○ Virtual physician visits that don’t require having to go into an office.
○ Telemedicine that allows the remote review and exchange of health care data to improve access to rural areas, allow for multiple specialty consults in one visit, share images. ● Patients experience technology differently (access, interaction with the provider). ● For the future, the technologies that promote the greatest degree of self-reliance or achieve cost effectiveness will be the direction to follow.
