Becker's Hospital Review

Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 their relationship in late 2012 when they formed an alliance to better manage chronic conditions through accountable care models and alternative delivery systems. More health systems are also responding to employers in their marketplace and companies' concerns over the costs of employee healthcare. Bostonbased Steward Health Care launched Steward Community Care in February 2012 for small businesses within the coverage area of Fallon Community Health Plan. The specialized plan offers premium savings of at least 20 percent. Other providers are partnering directly with employers, such as Cleveland Clinic, which finalized a bundled payment arrangement with the Boeing Company in fall 2012. It will be interesting to watch how these strategies continue to evolve in the year ahead. 8. Engaging patients in their health Efforts to improve population health and take on risk will both require hospitals to place as much focus on prevention and wellness as they do treatment. Hospitals will be required to not only take care of patients within their four walls but also encourage patients to manage their own healthcare as well. While some hospitals already engage in community outreach activities, a more concerted, systematic effort will be necessary to make long-term changes in health behavior. The challenge derives from how to provide patients with resources, information and opportunities to do a better job of managing their own health — a goal that may seem counterintuitive but will be financially incentivized as reimbursement models change. In order to manage patients as a population, hospitals and health systems need access to a wide array of data. Full access to patient data across the care continuum will help hospitals to take a focused approach to changing patient behavior. For instance, many professionals suggest engaging patients in their care by meeting them where they are — offering them healthcare choices and resources based on their demographic data, location and socioeconomic status. Assessing and addressing a community's needs forces hospitals look at the entire patient population instead of the disease. Some within the healthcare industry have criticized healthcare reform for making providers responsible for their patients' adherence to treatment plans and, in some cases, overall lifestyle choices — things providers may not be able to "control." However, forward-thinking hospitals and health systems see the law as an incentive to achieve better health outcomes through patient education and engagement — a goal that will benefit individual communities and government spending. 9. Making sense of big data The digitization of the healthcare industry is leading to "big data," which refers to the terabytes of data collected 24/7 in an organization's information and clinical systems. A single hospital stay for one patient alone generates tens of thousands of data elements (e.g., all medical supplies and billing information for every clinical procedure). Although the healthcare industry is only at the threshold of full-scale healthcare electronic medical record adoption, there is extensive optimism about how digitizing health records will lead to big data. Hospital and health systems can leverage this big data in order to effectively prevent readmissions, prioritize population health management goals and succeed in accountable care organizations. However, activating a big data resource requires using sophisticated technology to quickly and accurately collect, integrate and analyze this massive data resource. The sophisticated technology needed to capitalize on big data is harder to come by than the data itself. While no one method or strategy for aggregating patient data will apply to all systems, all methods must result in reliable data. Only quality data translates into quality analysis. A clean data warehouse is the foundation of all data-driven analysis. All financial and clinical data points — everything from vitals to point of entry to procedural codes — must be consistent to ensure proper reporting and validity for modeling. 17 By integrating this vast number of patient attributes, the data warehouse very quickly becomes a data asset capable of producing key patient, financial and quality metrics. Data mining algorithms can run on the data warehouse to build models. These models zero in on correlations within the entire history of patient accounts, charges and clinical data elements to determine the key attributes, which will help hospitals create decision support mechanisms and prioritize population health management goals. The ultimate solution to maintaining data integrity will not originate from one hospital but a collective and cost-effective effort from all healthcare providers across the industry. 10. Maintaining compliance while cooperating with heightened and new regulatory audits Hospitals can best avoid legal scrutiny by ensuring thorough compliance, but this may be an uphill challenge in 2013 as federal agencies intensify their regulatory efforts. The Office of Inspector General listed several hospital-centric initiatives in its work plan for this year, such as identifying trends in same-day readmissions, reviewing the effects of physicians billing Medicare as provider-based physician practices and keeping a close eye on how hospitals bill discharges and transfers. The federal government is not only strengthening its fraud-fighting efforts, but also has grown quite vocal about them. For instance, in September 2012, HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder mailed letters to five major hospital groups about the government's zero-

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