Healthcare looks to data to help solve primary challenges in the access, quality and affordability of care in the wake of realising universal health coverage,, but the sharing of data is bedevilled by 'a level of mistrust' between insurers and doctors, writes JG Cowper, business intelligence specialist at Healthbridge.
Cowper writes:
"Healthcare is looking to data to help solve primary challenges in the access, quality and affordability of care in the wake of realising universal health coverage (UHC). But on a continent plagued by one of the highest disease burdens in the world, stark socioeconomic inequalities and huge disparities between public and private care, how are we practically using data to solve some of the challenges we face?
“Over the last decade, public and private healthcare have started embracing the importance of having digital data available to transform a static paper-based system into a connected health service that is centred on the patient. The healthcare sector has taken arguably slow but steady strides towards digitisation, particularly in private healthcare. But because the majority of electronic data being captured in private care is used by medical schemes for reimbursement purposes, doctors haven’t been able to use that same data in a way that is meaningful to them. Until recently.
“Doctors naturally play a critical role in the collection and quality of the health data that’s being collected. Although relatively new, more and more private GPs, surgeons and specialists are adopting electronic health records (EHRs) and automated billing and practice management solutions to capture data about their patients and their practices. On the opposite end, medical insurers have been collecting and analysing health data for much longer and have developed sophisticated BI tools to understand the cost of private healthcare, keeping members health records to reduce claims and manage risk, for example.
“What we’re left with are two key stakeholders on opposite ends of the spectrum who find it difficult to discuss and resolve important questions about the cost, quality and availability of care. Without shared data as the common ground from which to work from, adding more stakeholders to the equation would make planning and resolution even more challenging. And as the government rolls out National Health Insurance (NHI), private healthcare will undergo some of the biggest changes and the need for closer collaboration between doctors and insurers (and other stakeholders) is more important than ever.
“The notion that payers and providers should share data is widely discussed but in reality, it is easier said than done. Insurers, in part, use data to identify and eliminate fraud and exploitation. While doctors are primarily concerned with getting care to their patients, what often results is a level of mistrust between them.
“But that doesn’t mean that doctors and insurers should be using different data for information. As a business partner, Healthbridge is in a unique position as a neutral party to first provide data to the medical aid to substantiate reimbursement before repurposing it for the doctor so that it doesn’t talk about a claim, but instead about a patient and the clinical engagement.
“Doctors are asking for this kind of information and without accessing or changing claims data, Healthbridge can use it to aggregate insights for doctors that are relevant to them. Insights like: the number of procedures performed, how many of which were approved by medical aids, how many procedures were performed using a particular drug, etc. What this does is removes the ambiguity in claims data to facilitate rich discussions between doctors and insurers to start building trust and collaboration between them.
Data that enables quality
“Once doctors have answers to some of their questions about patients, procedures, outcomes, profitability and planning using this aggregated data, they have a 360° view of their business and their performance. But one step further than that is what results when clinicians of the same discipline take a view of their collective data which allows them to start engaging with each other about quality.
“Clinicians within a specific discipline that are in agreement about the protocol for a diagnosis and consensus about how to carry out procedures are applying high level of academic rigour to give patients the best possible treatment following diagnosis.
“A study carried out by Healthbridge in collaboration with surgeons revealed that extracting insights from claims data gave surgeons the basis with which to start realising true intra-disciplinary care, which in turn improved the quality of care being offered to patients. What follows from this milestone in data-driven, connected care is the ability for clinicians of different disciplines to work together to give patients the best quality care, at the most affordable price. In other words, better value healthcare.
“As the next step from surgeons working together within their discipline, care can become interdisciplinary to include anaesthetists, specialists, doctors, nurses, etc. for example. What this means for South African healthcare is that we can move away from the silos that exist to build the necessary frameworks to support changes in the way we currently fund and reimburse care. It’s widely acknowledged that the fee-for-service model in use is both unaffordable and ineffective in improving quality, but by using data effectively we can make huge strides towards value-based care models of reimbursement – the cornerstone of affordable, patient-centred care.
“Once we have started using data purposefully as a basis for communication between key industry players, and to enable better quality between disciplines, what we can expect to see over the next decade is data being used across the private and public sectors to enable preventative care on an outcomes-based reimbursement model. The greatest cost burden in South African healthcare comes from treating preventable chronic disease and the benefit of maturing in how we use data currently will help us to identify, pre-empt and measure prevention in population health.
“The catch is that we are currently collecting diagnostic codes that can’t readily be used for predictive analysis or preventative care measures. We will eventually reach a stage whereby we will need to use a more sophisticated medical terminology to be able to access more insights from health data but for now, our focus should primarily be on enabling doctors to use templates, embedding alerts within our technology to ensure compliance and intradisciplinary benchmarking and to introduce more refined data management processes between stakeholders.
“Going through the stages of proactively using data to solve current, practical problems are the building blocks we need to build a truly connected health system. One whereby stakeholders, and particularly doctors, are empowered to ultimately provide affordable, high quality care to patients. Healthbridge is demonstrating that the data that is being collected is valuable to ease some of the tensions that exist within the industry and that we’re not just collecting data for the sake of data or to support a one-sided approach to delivering care.
“So, can data save healthcare? No, not in isolation. But if we are using data to build trust between people, and to open communication between those people to improve the quality of care and finally, measure our performance, then we are using our data to take proactive, incremental steps towards making universal health coverage, and all its benefits, a reality.”