Business Intelligence improves the bottom line

Healthcare industry focuses on driving better outcomes

Business intelligence is finding myriad ways to improve the healthcare organization’s bottom line, whether it’s through clinical improvement, greater operational efficiencies or enhanced revenue cycle functionality, system designers say.

Take, for instance, medical device integration into the electronic medical record. The focus of the project from a BI perspective is to process clinical information at the point of care, where the data can be used to drive better clinical outcomes, says Dave Dyell, founder and CEO of Panama City, FL-based Isirona.

“Making better decisions with data-driven care is the BI angle,” he said. “It is about clinicians using the data to treat patients.”

Making existing staff more efficient is another bottom line benefit of BI, Dyell says – especially in light of the nursing shortage that many providers have experienced. Automated point of care information saves valuable nurse time on taking patient vitals, which can easily add up to a couple of hours per nurse, per shift, he says.

“Another benefit we see on the data analytics side is the ability for early identification of potential problems and earlier intervention,” said Dyell.

To be sure, access to critical information in real time is the hallmark of a BI system, says Eric Mueller, services president for Seattle-based WPC.

“BI is about making good decisions with accurate information in as close to real time as possible,” he said. “That is important because if the information in front of you is 40 to 60 days old, that isn’t business intelligence, it’s business history.”

‘Synchronization’ essential

Newton, MA-based Curaspan Health Group connects providers, payers and related suppliers through a web-based transition network that CEO Thomas R. Ferry calls a “synchronized patient management solution that is interoperable with health information systems in the acute and post-acute sectors.”

The Curaspan platform serves as a foundation for accountable care organizations, health information exchanges and the evolving bundled payment and models of care standards.

“One of our tenets is ‘you can’t manage what you can’t measure’ and it takes an IT platform to help you do both,” said Ferry. “Our approach is to use the combination of content, service and workflow tools to address mission-critical processes. The key is transition management from one care setting to another for patients. By applying those tools to a very intensive process, we have been able to drive best practices.”

Holistic approach

Chor-Ching Fan, senior director of analytics product management for McLean, VA-based LogiXML says BI is “exploding” and healthcare is seeing “the third wave of its BI evolution.” Adopting BI in healthcare is a bit different from other industries, Fan says, because “healthcare is a combination of art and science.”

In terms of product requirements for healthcare, a BI system “needs to be pervasive,” Fan said. “It can’t just be for executives – there is so much opportunity for benchmarking the clinical workflows and processes.”

Healthcare organizations need to know the details of what goes into the provision of services, such as how long services take and how long patients have to wait for service, Fan says. A holistic approach using dashboards, charts and analytics allows managers to see how long things are taking in the care process, he said.

Maximizing revenues

Revenue cycle management is critical for all provider organizations – none more so than cash flow-challenged physician clinics, says Taylor Moorehead, partner for Carmel, IN-based Zotec Partners’ west region.

To help physicians collect the maximum amount of revenue from payers and patients, the Zotec Partners BI system uses analytics to look at pay patterns so that physicians can negotiate better contracts with payers and establish payment terms with patients, said Moorehead.

To illustrate how BI works for claims processing, Moorehead uses this example: if a clinic sends in 1,000 claims and the insurer pays 700, there is a 30 percent denial rate, and it is up to the provider to figure out why those claims weren’t paid. Using BI principles, the accounting staff can track CPT codes, ICD-9 edits and all the carrier-required elements to figure out why those claims weren’t paid.

“If you’re not tracking, slicing and dicing, you can’t improve or educate anyone about the process,” he said. “Without it, you’re DOA.”

Primary care physicians are among those providers at greatest risk of revenue loss due to reimbursement cuts and a growing number of uninsured patients, adds Jim Rose, senior vice president of business development for Burlington, VT-based Patient Engagement Systems.

He summed up the situation this way: “How can primary care providers improve their revenue position? The only thing they can do now is fill their appointment books and charge people for canceling appointments. It is an airlines type of mentality – people better show up or we’ll lose money. So if physicians are adapting those practices, they are going in a bad direction.”

To achieve the goal of a more “comfortable” reimbursement position, Rose says practices need to use BI to “create meaning out of loose, disparate data.” That means harnessing and presenting data to payers to prove quality patient care.

Indirect ROI benefits

Since adopting a BI system from Orlando, FL-based Pentaho, Loma Linda University Health Care in Loma Linda, Calif., has upgraded its decision support capabilities “without breaking the bank,” said analyst Duncan Henry. While the health system expects to see upfront and ongoing cost savings with the system, Henry points out that he has seen some indirect benefits to the ROI as well.

“Being able to download and evaluate the product was also beneficial,” he said. “We looked at one proprietary product that had a very siloed approach and would have required significant tailoring to our existing setup to get it to fit, whereas Pentaho hooked right up to our data warehouse without a hitch or having to resort to lots of service calls to either IS or the vendor.”

As Henry and his team begin to automate many of Loma Linda’s manual processes, they have started to increase their data output to match growing demand without having to add extra staff, he said.