Appealing to the New Healthcare Consumer

Use your data

Published: Wednesday, May 3, 2017 - 12:02

As high deductibles and escalating costs drive patients to take a more active role in their healthcare, providers are waking up to the fact that they need to pay attention to what buyers want. But uncovering those consumer insights and using them to drive organizational strategy remains a challenge for most providers.

In the first annual State of Consumerism in Healthcare survey, two-thirds of healthcare leaders see consumer-centricity as an above-average organizational priority. And yet, less than one-quarter feel they have the capability to gather strategic insights about those consumers.

You know more than you think you do

Thanks to the Centers for Medicare & Medicaid Services (CMS), providers are reporting a plethora of information about many of the factors that healthcare consumers care about—such as cost, quality, patient experience, and availability of information.

Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS is expected to make even more information readily available to consumers as soon as 2020.

Rather than simply turning these data over to CMS, use it to inform your organizational strategy. For example, the Quality and Resource Use Report (QRUR) shows data on quality and cost of care that will affect Medicare Part B fee-for-service payments and benchmarks the performance of peer groups.

As these reports are released by CMS, identify the services that score in the upper quartile of your peer group in terms of quality and cost. Then capitalize on the fact that your practice is providing high-value care by communicating that information to the key constituents who influence the patient’s choice of providers:
Physicians. If your hospital is performing cost-efficient and high-quality knee replacements, communicate that information to all network and independent physicians who might refer patients for that procedure. Make sure they are prepared to communicate to their patients why and how your hospital is achieving these positive outcomes.
Payers. Commercial payers are looking for evidence that your practice will provide high-value care. Rating highly in one or more CMS value-based programs can help your health system or physician practice land on another payer’s preferred provider list.
Employers. Employers are playing a crucial role in the shift to consumerism. Some large corporations, such as Boeing, are contracting directly with health systems that can demonstrate they deliver high-value care.

Targeting areas of improvement

For areas where your organization showed weaker performance, dig into the data to understand why. Perhaps your orthopedic surgeons are prescribing two different courses of post-surgical therapy. Is one associated with significantly better outcomes? If so, how do the costs align with that course of therapy?

Historically, CMS data have been primarily reported at the facility level, so understanding provider-level performance will require reporting from your electronic health records (EHR). If there are concerns your practice has any data quality issues, address those prior to conducting an individual provider analysis.

Once your practice has reliable data on providers’ outcomes, share that information with them and initiate a discussion to understand what is behind the variation. By consistently showing physicians data on their outcomes, you can begin to build consensus on moving toward more consistent, high-quality protocols. As these process improvement efforts begin to bear fruit in the form of higher quality and resource use scores, leverage those proof points in your communications with consumers.

Consumers will continue to demand more readily available information about cost and quality in every sector, and healthcare is no exception. The good news is that you have access to plenty of information about your strengths and weaknesses. So, roll up your sleeves, dig in to the data, and be prepared to use what you learn to inform your organization’s strategy.

This article first appeared in the April 14, 2017, Horne CPA and Business Advisors blog.

About The Author

Brooke Pierce

Brooke Pierce is a senior manager in healthcare services at HORNE LLP. Pierce performs valuations of healthcare entities, including medical practices, hospitals, ambulatory surgery centers, diagnostic centers, and joint ventures. She also specializes in valuation of medical equipment and office furniture as well as intangible assets. Additionally, she performs valuations of contractual arrangements involving healthcare entities and providers such as block lease, management services, and professional services arrangements.