Employer-sponsored health clinics are a solution for healthcare costs and employee productivity issues significantly affecting the organizational bottom-line. Actionable information is essential to risk-bearing healthcare organizations in order to assist the key stakeholders’ understanding of populations they serve by delivering understandable, consistent information. Analytics are generated by incorporating multiple data sources, such as healthcare claims data, electronic health records, survey and assessment data, human resources data, as well as others. This ensures measurable, data-driven, reliable messaging – a requirement for successful and sustainable healthcare programs.
In order to appropriately support the implementation and on-going operations of an employer-sponsored health clinic, the following analytic methods are essential.
Accurately predicting clinical, interventional, and financial outcomes provides insight into relevant patient population information to drive appropriate action, improve clinical outcomes, and control costs. The focus of these types of analytics is to assign individualized and composite risk scores to patients based on their risk for high cost and utilization as well as their likelihood to engage with healthcare professionals to impact and control chronic conditions. This information allows stakeholders to better allocate resources needed to increase program effectiveness.
Appropriate and accurate documentation is essential to a risk-based healthcare program. An analytic solution is essential to assist in correctly identifying and correcting these types of errors. The most effective method is to develop profiles of each individual healthcare provider to ensure the clinical documentation supports medical necessity and clinical severity of the patient. This information allows the organization to focus on the providers with the greatest documentation risk in order to more effectively manage their programs.
The ability to determine how a member’s “life circumstances” influences their healthcare behaviors and experiences is an important component in creating a successful program. This identification process helps organizations identify the psycho-social or life circumstances of targeted populations, their prospective health risks, and their service requirements. Insight into member specific life circumstances that adversely impact health outcomes enables a more targeted approach to enhancing a member’s health and the partnership with healthcare providers and care managers.
In order to create and sustain successful programs, organizational change must first occur and then on-going provider education and training should be used to create a provider-patient relationship. This relationship, in turn, sets the standard for a culture of health. This results in better outcomes, which translate into decreased healthcare costs as well as increased productivity.
Ultimately, a strong, process-oriented healthcare approach that includes (1) predictive analytics, (2) risk acuity assessment, (3) psycho-social or the life circumstances of the population, and (4) provider education and training will provide the information, intelligence, and insights for better decision-making in an employer-sponsored health clinic model.