Medical Groups: Focus on Federal and Commercial Incentive Programs
Medical groups are quickly moving from the traditional fee-for-service model to outcome-driven models for patient care, such as accountable care and medical homes. This trend is fuelled by commercial payers and health plans as well as multiple federal incentive programs such as PQRS, eRx, Meaningful Use, medical billing and coding, ACO and PCMH.
BI/Analytics: An Effective Way to Maximize Gains from Incentive Programs
Most outcome-driven incentive programs require medical groups to have an extensive view of data for clinical and financial performance management. Consequently, there is a strong interest in integrating, tracking and analyzing data from disparate clinical and financial systems, and using BI/analytics platforms to enhance the overall clinical and financial performance. Using BI/Analytics tools and platforms, medical groups can:
- Define, manage and track clinical quality measures
- Monitor short-term and long-term patient outcomes
- Implement real-time clinical alerts based on evidence-based guidelines
- Make electronic data submission to regulatory bodies like CMS
- Address operational performance and RCM reporting issues
BI/Analytics: Key Challenges for Organizations to Effectively Use BI/Analytics
The healthcare industry has been plagued with many challenges which have prevented it for effectively using BI/Analytics platforms for clinical and financial performance management. The key issues have been:
- Data integration: Ability to integrate clinical and financial data across multiple 3rd party applications in a consistent manner e.g., patient matching, terminology mapping, proprietary data formats
- Data quality: Ability to address data quality issues across heterogeneous clinical and financial systems
- Data abstraction: Ability to provide data abstraction capabilities based on specific measure definitions across multiple reporting initiatives such as Meaningful Use, PQRS, P4P, PCMH, etc.
- Flexible reporting: Ability to provide reporting and analytics for overlapping and inconsistent requirements across multiple health plans, commercial and payer organizations
CitiusTech’s BI-Clinical platform for healthcare BI/analytics offers more than 600 pre-built, out-of-the-box KPIs for clinical and financial performance management, with comprehensive coverage of industry and regulatory initiatives for Medical Groups. You can find out more about our BI/analytics offerings at https://www.citiustech.com/products/perform-quality.
