As convergence around the needs of patients and consumers intensifies, payers, providers, and employers are collaborating beyond their traditional boundaries. IBM's Institute for Business Value and the AHIP Foundation's Institute for Health Systems Solutions recently conducted research on this issue and its implications and will release their findings at this week's 2013 AHIP Institute.
The researchers will also highlight the core skills that are required of healthcare organizations in an era of convergence and collaboration at the session on Thursday, June 13, as part of the track focusing on Advancing New Business Models, Capabilities and Innovation for a New Health Care Ecosystem, according to Barry Mason, vice president, Global Healthcare Payers at IBM, one of the presenters.
Healthcare reform, other legislative forces and the market are driving more converged business models beyond the traditional definition of a provider or a payer. The research draws out insights about what it means for businesses and how some companies are responding to create sustainability for themselves, such as carving out new market niches, creating new sources of revenue, and taking additional costs out, Mason said.
The research looks at different care models, starting with patient-center medical homes to enable care coordination and accountable care organizations (ACOs), which take collaboration further to involve some risk for providers in the shift from fee-for-service to fee for outcome-based models.
"We will give the audience a bit of a path for a maturity model of different process areas and competencies that they need to mature. One of those is calling out information and the use of analytics," he said.
Mason said that he hopes attendees will understand that they need to pay close attention to the impact that convergence has on their business models. "You still have leaders and …laggards, and you still have people in their core businesses," he said. "But the future leaders are embracing this idea of converging and have been investing in these competencies to make these changes and to carve out for themselves a sustainable role in the future of health care."
Another critical core competency is in culture and transparency and the ability to work outside of the boundaries of the current business model. The presentation will suggest areas through which attendees can assess their own businesses in order to build the foundation needed to advance in the converging marketplace.
In a separate presentation, "Using Predictive Analytics to Improve Member Satisfaction," Bob Dutcher, vice president of Marketing and Product Management, InsightsOne, will highlight using big data, machine learning and predictive analytics to resolve customer satisfaction issues before they escalate.
The session on Friday, June 14, is part of the track on Driving Value through Improved Operations. Ravi Chawla, director of informatics at Independence Blue Cross (IBC), and a customer of InsightsOne, will also present.
IBC has been able to predict which Medicare customers are likely to have or file a complaint. "This allows them to determine the cause and do proactive outreach to these 'at-risk' members to resolve the issue before it escalates into a complaint," Dutcher said.
The capability is important because it enables the organization to identify problems, such as claims or billing, address the immediate issue and fix the underlying problem, he said. As a result, IBC has had a significant reduction in complaints, which increases their overall customer satisfaction. It also improves their STAR rating, which affects its Medicare reimbursement, Dutcher said.