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Practical Innovation to Address Healthcare Challenges

Transforming Healthcare Through
the Power of Data

The amount of data that insurance companies, doctors, hospitals and patients have at their disposal is enormous. Payers have access to billions of pieces of claims data from doctors and pharmacies, while healthcare professionals across the country can collectively tap into millions of sophisticated electronic medical records that track patients and their progress. So valuable is all this information that some industry experts talk about data as the “new oil.” The analogy is fitting: both are the raw material for creating value.

That said, the ability to tie all these disparate pieces of information together is monumentally difficult. “Many of the challenges we face in healthcare today are the direct result of a fragmented system,” explains Tim Suther, senior vice president and general manager of data solutions at Change Healthcare, a leading healthcare IT company. “Our country spends more than $3 trillion a year on healthcare, and as a percentage of GDP, that is twice what any other developed country in the world spends, yet we are not the leader when it comes to quality and outcomes.”

Change Healthcare’s mission is to transform the healthcare system by deploying technologies including artificial intelligence (AI), machine learning, blockchain, analytics and cloud computing to restructure the way healthcare is delivered, measured and paid for. Given the fact that the company processes about $2 trillion in healthcare claims each year, Change Healthcare is in a unique position to work with payers, providers and consumers to create a more connected healthcare ecosystem, help improve patient outcomes, and help lower costs for all stakeholders.

Suther points to value-based care and population management as two areas where better analytics and insight can lead to an improved patient experience, lower costs and more efficient operations. The rise of value-based care is changing the way healthcare is paid for; rather than the fee-for-service model that has traditionally been used, value-based care injects quality and patient outcomes into the equation. The Change Healthcare platforms and software solutions capitalize on this approach by enabling doctors to track the effectiveness of the services they offer and see how they compare with other providers offering the same procedures and types of care.

When it comes to managing the health of defined populations such as patients with diabetes, heart conditions, or some other chronic condition, it’s vital to mine and analyze data from doctor visits, hospital stays, or even from across a regional healthcare system. For example, using Change Healthcare analytic solutions, a hospital can examine all its cardiovascular patient data to determine which patients need screenings or additional lab work. By addressing these patients today, the hospital can prevent more serious and costly care down the road. “If you don’t have information about what happens to your patients outside of your facility, it’s impossible to be successful in a value-based care model or assume risk for a given population,” says Suther. “However, as providers and payers use analytics to gain actionable insights from the data in their systems, they are well positioned to bend the cost curve favorably and improve outcomes for patients.”

The ability to aggregate the data gleaned from the claims running through its systems—and use that information in increasingly sophisticated and targeted ways—enables Change Healthcare to provide its customers with the intelligence to improve quality, reduce costs and make smart business decisions. For example, Suther says, if a health plan wants to expand into a new part of the country, it can use Change Healthcare data to identify the right hospitals and providers in that city for collaborative relationships.

Moving the needle on costs and outcomes is a challenging undertaking, but real progress is possible by using intelligent healthcare platforms, fueled by data sourced from across the entire health ecosystem. "Our mission is to connect data across all network participants, creating an unsurpassed breadth and depth of insight far beyond what any individual payer or provider can do on its own,” Suther says. “This networked insight provides the key to our country’s ability to achieve a value-based healthcare system where costs are lower and quality is higher, which benefits providers, payers and all of us as consumers.”