Healthcare Reform and the 5 Styles of Business Intelligence
The proposed healthcare reform bills currently in the United States Congress contain regulations which are intended to improve access to care, improve quality of care delivery and outcomes, and reduce costs. These bills build upon the reform foundation set by the original HIPAA bill in 1996, as well as the Medicare Modernization Act of 2003 and the more recent HITECH act of 2009. But how will we know if these laws are working? How do we know where we are now in terms of cost, access, and quality? And how will we know if we are improving as a result of these changes? The answer, at the surface, is simple – we have to measure, monitor, and report those metrics. Healthcare reform’s promise will be exposed to most Americans through one of the 5 styles of business intelligence.
Most of us have already been influenced on healthcare reform and what it means through predictive modeling as expressed through television and Internet advertising. The major stakeholders (with support from lobbyists) in our healthcare system have developed their own proprietary models to forecast future financial outcomes. Using various inputs (e.g. number of newly insured Americans, historical rate inflation, historical medical and pharmacy utilization rates) and the proposed laws, we can estimate the total healthcare spend and various other future values. These models are used to spread fear and doubt among the constituents, or to assuage those concerns, depending on where you stand. Other predictive models will be used to expand the investigation of healthcare fraud, identifying providers who may be participating in schemes to defraud Medicare.
Both the House and Senate bills contain legislation mandating more quality reporting for hospitals, long-term care, and physicians. These enterprise style reports, made available to the public through the Department of Health and Human Services via the Centers for Medicare & Medicaid Services (CMS), are more traditional. The data is generated and made available by the providers, mandated by CMS, in exchange for financial reimbursement incentives. The reports are formatted for output and generated on a regular basis, typically comparing two or more hospitals’ quality scores for a defined procedure, surgery, or clinical therapy.
Scorecards and dashboards will be used to monitor both our national and state level healthcare performance. Some of these will include analytics including heat maps and visualizations, like the Dartmouth Atlas or our own maps. Others will simply publish scores on key indicators comparing current performance to prior years, as the New Hampshire Center for Public Policy has done using their own key measures.
Ad hoc analysis will be put to use as part of the various demonstration programs to evidence based medicine programs, including childhood obesity and skilled nursing demonstration projects. One provision of the Senate bill “authorizes elimination of preventive services based upon evidence based medicine”. This comparative research, examining the relative effectiveness of new therapies compared to traditional treatments, will require software tools that enable interactive analysis across many dimensions of data, across large sets of data.
Business intelligence tools will grow in their role of enabling transparency and understanding of the effectiveness of these healthcare reforms. If you have any specific questions about business intelligence and the healthcare industry, please feel free to contact me at healthcare(at)microstrategy.com.
Tags: business intelligence, congress, dashboard, healthcare, medicare
