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•	 Cognizant Reports




Analytics-Driven Healthcare:
Improving Care, Compliance and Cost
In the face of skyrocketing costs, the healthcare industry is addressing
inefficiencies by improving data sharing and collaboration across the
industry value chain and applying analytics to improve operations
and patient outcomes.

     Executive Summary                                     health conditions and prescriptions, while semi-
     Ever-increasing costs highlight the inefficiencies    structured and unstructured data is available in
     that currently plague each link in the U.S. health-   e-mail, social networking sites, doctors’ notes,
     care industry’s value chain. If deployed properly,    test results, physicians’ commentaries, etc. The
     advanced analytics can play a significant role        integration of all this data is key, and this calls for
     in reducing these inefficiencies and providing        greater collaboration among the IT departments
     healthcare organizations with insights to manage      of healthcare organizations, care practitioners
     their business more proactively and profitably.       and claims processing experts.

     For example, analysis of electronic health            To fully exploit this abundance of data, health-
     record (EHR) data can lead to improved clinical       care organization must create a culture that
     outcomes and reduced readmissions, both of            places a premium on fact-based planning and
     which can lower costs and inspire patient loyalty.    decision-making. Evidence-based insights from
     This will become particularly important this          a variety of sources can be used to provide
     year, when hospital readmissions — which cost         valuable feedback to physicians.
     Medicare $15 billion in 20121 — will begin to be
     penalized by the U.S. Centers for Medicare &          Furthermore, as data volumes rise, a “pay-per-
     Medicaid Services (CMS).                              use” analytics model will help minimize costs for
                                                           healthcare organizations, large and small.
     Analytics, moreover, can help predict an
     individual’s future healthcare needs, which can be    Rising Healthcare Costs,
     valuable for both the payer and provider. Health-     Regulatory Pressures
     care organizations must, therefore, begin to set      Healthcare costs in the U.S. are ballooning.
     up internal systems that gather disparate data        The annual spend in 2012 was estimated at
     in one place. This includes both structured           around $3 trillion, or about 20% of the GDP.
     and unstructured data; for example, EHR pro-          This expenditure is twice that of any other
     vides structured data of a patient’s history of       industrialized country. What’s more, costs will




      cognizant reports | february 2013
increase by a projected 4% to 6% in 2013,                           mortality rate for acute myocardial infarction
which is more than the estimated 2.3% rate of                       (AMI) decreases by 7%. Moreover, the EBITDA
inflation.2 Despite technology and process improve-                 per bed increases by 14%, and the percentage of
ments, it is widely believed that the U.S. health-                  individuals who would recommend the hospital
care industry remains highly inefficient due to a                   increases by 0.8%.
lack of shared insights, collaboration, incentives
for cost control and quality healthcare research.                   Excessive compensation for physicians also
In fact, it is estimated that around $700 billion of                contributes to skyrocketing costs. Physician
the $2.5 trillion spent on healthcare in 2010 in the                salaries in the U.S. account for 8.6% of total
U.S. represents unnecessary expenditures.3                          healthcare costs. In absolute dollar terms,
                                                                    U.S. physicians earn more than physicians of
Relief may be on the way. Federal regula-                           other nations, as the average per capita health-
tions mandating better health outcomes are                          care spend in the U.S. is $2,600 more than the
pressuring the industry to become more efficient.                   next highest spending country.7
The Patient Protection and Affordable Care Act
(PPACA), for example, addresses the twin goals                      Deploying Analytics
of reducing healthcare costs and improving                          In this scenario of runaway healthcare costs — as
quality of patient care. It clearly ties reimburse-                 well as growing regulatory pressure for affordability
ments to the performance of healthcare organi-                      and improvement in clinical outcomes — analytics
zations. A percentage of these reimbursements                       has emerged as a silver bullet for the healthcare
will take into consideration the efficiency of the                  industry. Analytics can generate insights that
healthcare organization, as well as patient satis-                  lower costs, reduce inefficiencies, identify at-risk
faction metrics.4                                                   populations, predict individuals’ future health-
                                                                    care needs and support physicians’ diagnoses.
Unnecessary procedures are one cause of the                         Analytics can enable more efficient use of
cost spike. According to a survey published by                      resources by ensuring that those who need care
Archives of Internal Medicine, 43% of respon-                       the most receive it.
dents said many patients are asked to undergo
unnecessary tests by physicians.5                                   In short, analytics can be used to:

According to a McKinsey report,6 effective                          •	   Build multidimensional predictive models.
hospital management strongly correlates with                        •	   Reduce costs.
high-quality care. When the quality of hospi-                       •	   Improve outcomes.
tal management improves by one unit on a                            •	   Empower patients.
scale of 1 (worst) to 5 (best), the report says, the



Multidimensional Predictive Models
Today’s Industry Model                                              Future State
Care Management Identification                                      Care Management Identification
                                                                                   Convergence of health and
                                                                                      nonhealth insights
                    Medical                                         Health-based                               Third-party
                  claims data                                         member                                    consumer
                                                                      insights                                   insights
                                   Health
                   Health-       assessment                                            Multi-dimensional
  Pharmacy          based           data
                                                   Stratification                      member insights
 claims data       member             Predictive     and care
                   insights           modeling       outreach
                                                                                          Predictive
                                                                                          modeling
    Wellness                      Health
                                                                                                           Outcome Goals
                                screening
  activity data                                                                          Stratification    • Higher engagement
                                   data                                                      care          • Improved health
                                                                                           outreach        • Reduced healthcare
                                                                                                             costs

Source: "The Promise of Healthcare Analytics," Healthleaders Media, 2012.
Figure 1


                                            cognizant reports       2
Multidimensional Predictive Models                      short-count pills and fill prescriptions without a
Prior to the signing of the PPACA into law              refill and then overbill Medicaid.
in 2010, payers and providers disagreed on
accountability for controlling healthcare costs.        Such fraud can be reduced by using rule-based
Today, both parties agree they must work                algorithms.12 For instance, on the payer side of the
collaboratively and share accountability for the        healthcare equation, a business rule might ask
total cost of care. Therefore, information about        for closer inspection of a claim when it exceeds
patient health is increasingly being combined           a benchmark dollar amount. Similarly, an alarm
with nonhealth information and third-party              could be triggered if multiple medical proce-
consumer insights to create multidimensional            dure codes are used instead of a single code or
predictive models. These models lead to better          if a claimant submits an unusually high number
stratification that, in turn, leads to higher engage-   of claims.
ment, improved health and reduced healthcare
costs (see Figure 1, previous page).                    Lack of access to healthcare also contributes to
                                                        industry inefficiency, as the need for services is
Reducing Costs                                          sometimes greater than the healthcare resources
Because healthcare services come with a price,          available. The decision to provide a service should
organizations are incentivized to seek volume           be driven by the relative merit of the patient’s
over value. This model encourages repeat visits         need. Surplus resources can then be made avail-
to healthcare providers, readmissions and other         able to those who really need them. Analytical
inefficiencies that increase costs. Analytics can       models can be built on the basis of demographic
be used to implement a payment method based             characteristics to inform this decision-making
on performance, where instead of volume, the            process, thus increasing access to healthcare to
provider would be paid for value, as determined         those most in need.13
by outcomes.8
                                                        Improving Outcomes
This model can be achieved by structuring the           The healthcare industry across the globe is
payment system so that the payer assumes the            moving from volume to value. As such, clinical
“insurance risk”9 and the provider assumes the          outcomes are more impor-
“performance risk.”10 Providers can then use            tant than ever. Healthcare An evidence-
available patient data to deliver better solutions      industry-related data is based approach
that are focused more on outcomes and value             increasing at a rate of 35%
than on volume of patient care.                         per year due to increased
                                                                                          to collecting
                                                        use of EHR capabilities and and analyzing
Additionally, the Health Insurance Portability          other forms of unstructured information from
and Accountability Act’s (HIPAA) privacy rules          data generated by social
permit the disclosure of protected health infor-        Web site and mobile device
                                                                                          various sources
mation (PHI) for research without the authori-          usage. Advanced analytics can be employed to
zation of the individual.11 Data-driven models are      can help organizations more enable appropriate
being used to identify disease risk factors. By         effectively mine this data to
using these models to identify at-risk populations,     improve health outcomes.14
                                                                                          intervention for the
providers can initiate treatment earlier, thus          Additionally, an evidence- physician at the
reducing costs. In fact, early diagnoses often lead     based approach to collecting point of care.
to treatments that use less expensive medicines         and analyzing information
or no medicine at all.                                  from various sources can be employed — including
                                                        practitioner research papers, technical reports,
Fraud committed by healthcare provider person-          clinical trial studies, expert views, patient charac-
nel is another cause of growing costs. Such fraud       teristics, etc. — to enable appropriate intervention
can take the form of duplicate scripts or filling       for the physician at the point of care.
multiple prescriptions for the same drug. These
activities increase revenue for the provider and        Minimizing Readmissions
unintentionally create incentives for employ-           Nearly one in five Medicare patients in the
ees to commit fraud. For example, employees             U.S. is readmitted within 30 days of hospitaliza-
can substitute generic drugs for brand names,           tion.15 Healthcare providers are increasingly using




                                 cognizant reports      3
advanced analytics to improve after-treatment         among the use cases in which advanced analyt-
care by gaining insights into treatment trends        ics can drive thoughtful and effective preventive
and causes for readmission and designing inter-       care strategies.
ventions. A leading U.S. healthcare provider has                                      In an increasingly
reduced readmissions by 22% through the use of        Educating patients about
analytics.16                                          their health conditions and
                                                                                     competitive
                                                      taking precautionary mea- world, where
Beginning in 2013, CMS will begin penalizing          sures will also help health- reimbursements
providers for readmissions beyond a stated            care providers establish
cut-off for some conditions.17 Total penalties        preventive care initiatives.
                                                                                     are declining and
for 2013 are estimated to reach $280 million.18       Effectively       disseminat- proof of better
Hospitals that fail to show readmission rate          ing information through care is required
improvements will be penalized up to 2% of            patients’ preferred chan-
Medicare reimbursements in 2014 and 3% in             nels is vital to encouraging
                                                                                     to improve
2015.19 Moreover, more chronic conditions will        them to access requisite clinical outcomes,
be included on the readmission penalty list in        information about their organizations need
the future, including cardiac bypass surgery          conditions and share pre-
and chronic obstructive pulmonary disease.            ventive measures. With
                                                                                     to analyze all the
Analytics can be used on the EHR data of patients     increasing use of smart- data they can get
with chronic conditions, as well as other discharge   phones, mobile applications their hands on.
procedures, to identify the target population and     can be used to educate
enhance patient monitoring with appropriate           patients and for outreach. These applications can
post-discharge plans that reduce readmissions.        help access physician guidelines and share health
                                                      information, such as sugar levels and blood
It is, therefore, imperative for healthcareorgani-    pressure levels. The key here is providing
zations to prepare and understand their readmis-      accessibility to portals through smartphones.
sion metrics, calculate their readmission rates
by condition and physical performance and com-        Health information wellness calculators should
pare outcomes with benchmark rates. This is a         also be accessible on-the-go.20 These wellness
highly data-intensive analytical process that will    calculators can help determine average walking
benefit healthcare providers by reducing penal-       speed, stride length, calories burned by activity,
ties or, better yet, avoiding them. Providers can     resting metabolism and also body fat percentage
also use patients’ demographic data to conduct        (see sidebar, next page). Once these details are
a risk assessment, identify at-risk patients and      obtained, an individual can decide whether it’s
prioritize their treatment.                           necessary to contact a physician. Moreover, this
                                                      unstructured data is ripe for predictive analysis
Preventive Care                                       that can help improve patient outcomes and lead to
Historically, healthcare has been considered          better management of the healthcare ecosystem.
a local service, and comparing it with related
geographic markets was considered unnecessary.        Significant data is available on the payer side,
It was not price sensitive or driven by market        as well. Predicting patients’ future healthcare
needs, so operational analysis was considered         needs would greatly benefit at-risk patients.
a waste of resources. Even if it were important,      For one leading payer, 4% of customers account
healthcare institutions either lacked appropriate     for 50% of its cost. If the insurer could identify
technology or were saddled with outdated IT sys-      and engage that small customer segment to
tems that in many cases did not offer data analysis   better manage their health, it could improve not only
capabilities.                                         cost control but its healthcare outcomes, as well.

However, in an increasingly competitive world,        Empowering Patients
where reimbursements are declining and proof          Consumers can and should become more respon-
of better care is required to improve clinical        sible for their own health if they are provided with
outcomes, organizations need to analyze all the       more relevant and timely data-driven insights.
data they can get their hands on. Stratifying the     They can, for instance, select the best provider
population, identifying patients at risk, analyzing   in their vicinity by examining a report card on
gaps in care and elevating pre-care planning are      various institutions. Customer relationship


                                cognizant reports     4
management and marketing techniques used                  	 In a survey of 263 healthcare professionals,
in retail can also be emulated to understand                71% of respondents cited data integration
appropriate communication channels for patients             from multiple sources as a main goal, while
to disseminate the right message at the right               56% indicated data standardization was a top
time. For instance, a monitoring system is avail-           priority. More than 8 in 10 (86%) said these
able that monitors a medication prescribed for              goals were difficult to achieve.21 The standard-
diabetes patients at prescribed intervals and               ization problem is clearly visible in physician
sends text messages or makes phone calls as a               notes,22 as their descriptive narratives can be
therapeutic reminder.                                       difficult to analyze. Techniques such as natural
                                                            language processing (NLP) can help mine criti-
Data Standardization, Integration and                       cal details from such unstructured data.
Collaboration Challenges
While there are many possible benefits to be              •	 Lack of collaboration across the health-
obtained using analytics, challenges remain,                 care value chain: Most organizations con-
including the following:                                     sider the data they generate to be proprietary
                                                             and sacrosanct and are, therefore, unwilling
•	 Lack of data integration and poor standard-               to share that data with other stakeholders.
   ization: Historically, healthcare organizations           EHR vendors have built data warehouses
   have lamented the insufficient funds available            and are beginning to share masked patient
   for IT investment. Now, the issue is a lack of stan-      data with their clients. For the accountable
   dardization and nonexistent data integration.             care organization model to be successful,




   Quick Take
Mobilizing Via M-Health
Helping consumers and patients fill an active role in healthcare is an essential component of the new
healthcare business model. The explosion of mobile devices and apps dovetails with this requirement.
Mobile health, or “m-health,” fulfills two key needs: enabling consumers to manage their health service
relationships more easily and giving individuals powerful portable tools for managing chronic conditions
and staying well.

One application we have developed at our clients’ request will allow consumers to easily manage their
health plans from a variety of computing platforms, including smartphones and tablets. The app enables
them to search for providers, receive immediate explanation of benefits notices, get messages about
coverage changes, obtain a secure ID card for use at physician offices and emergency departments, and
use a variety of ease-of-use features, such as click-to-call. Another app offers personalized wellness
management via smartphone or tablet. This app enables patients and members to easily enter or auto-
matically download health information, such as blood pressure, blood sugar, cholesterol levels, weight,
body measurements, etc. Then, in easy-to-read charts, the app shows them how their current results
relate to their goals and offers a variety of tips and information to help them achieve those goals.

Authorized physicians may access data from the app to monitor patient progress more frequently, with-
out the time or expense of office visits. Plans and physicians may also customize the app to be alerted to
changes in a patient’s condition that require intervention. Employers may even use the app in wellness
campaigns, with games and graphics encouraging participation. The objective of these features is to
prevent minor conditions from escalating to more serious problems that cost more to treat and manage.
Apps like these will put health management tools literally at the fingertips of consumers and patients,
giving them the more active role in their health choices they are demanding – and that will help reshape
healthcare.

This article originally appeared in Cognizanti Journal, Volume 5, Issue 1, 2012.



                                   cognizant reports      5
increased collaboration and sharing of patient         The Way Forward
   information among different healthcare                 Funding from the government for EHRs will be
   providers should become a wider practice.              made available only to organizations that meet
                                                          the proposed CMS criteria for the meaningful
	 Other players see analytics as a com-                   use of EHR (see Figure 3, next page). Healthcare
  mercial opportunity. Organizations with                 providers were mandated by CMS to begin
  analytics expertise offer their services to             capturing and sharing data in 2011-12. Provid-
  health information exchanges23 to improve the           ers need to use advanced care processes with
  quality of information and outcome of care.             decision support in 2014 and show improved
  Pharmaceuticals companies and the research              outcomes by 2016. If these criteria are not met,
  arms of insurers have aligned to explore                their reimbursements from Medicare will be
  ways to improve the health of the elderly and           reduced.26
  individuals with chronic conditions. Payers
  have rich sources of information on claims              The resulting decision support systems will be
  with disease codes from patients admitted               based on analytics that take health information
  to different clinics and other administrative           from the established EHR and other health IT
  information. If this data could be combined             systems and apply statistical/artificial intelligence
  with the patient information generated by               techniques to identify various risk factors, strat-
  providers, it could provide a wealth of action-         ify patients based on health conditions, provide
  able insights.                                          actionable information to physicians at the point
                                                          of care and measure progress on health outcomes.
	 Kaiser, an integrated provider and payer, for
  example, was able to reduce 30-day readmis-             Given that healthcare organizations can reap
  sion rates at one of its medical centers from           multiple benefits from using analytics, it is
  13.6% to 9% in six months by using a collab-            imperative that they create an environment
  orative payer/provider approach.24 Aetna, one           conducive to nurturing this capability. They must
  of the largest private insurers, partnered with         create a knowledge- and analytics-driven culture
  BayCare health system to improve manage-                that pervades the entire organization. In fact,
  ment of patients with chronic conditions such           all clinical information stored in standard data
  as diabetes and heart failure, as well as reduce        formats such as EHRs must be captured and trans-
  readmission costs.25                                    formed into actionable data on which analytics
                                                          can be applied. The following principles should be
Other challenges include limited access to skills         considered when building a framework for data
and resources, the lack of a clear vision on the          use across the healthcare industry:
benefits of analytics, and limited funding and
management support for analytics (see Figure 2).


Challenges of Analytics Use
60                                                              Poor data quality: Diverse data sources makes it
   52.2%                                                        difficult to create a single source of the truth
        48.3%                                                   Limited access to skills and resources
50
             43.5%                                              Information is not available in a timely manner,
                 39.7%                                          so decisions are made without being data driven
40                     39.2%
                                                                Limited analytics champion/sponsorship
                                                                Lack of a clear vision on how the organization
                                27.3%                           can benefit from analytics
30                                      26.8%
                                                                Poor data: Too many manual systems deployed,
                                                                resulting in insufficient electronic data
20
                                           16.3%                Poor data: Transactional systems exist,
                                                                but data cannot be unlocked easily
 10                                                6.7%         Culture not ready to become a
                                                                data-driven organization
 0                                                              Other


Source: "Business Intelligence/Analytics Survey," Healthcare IT News, February 2012.
Figure 2


                                cognizant reports         6
CMS Criteria for Meaningful Use of EHR

             Stage 1                                 Stage 2                                  Stage 3
            2011-2012                                  2014                                     2016
     Data capture and sharing                Advanced clinical processes                  Improved outcomes

 Electronically capturing health          More rigorous health information     Improving quality, safety and efficiency,
 information in a standardized            exchange                             leading to improved health outcomes
 format
 Using that information to track          Increased requirements for           Decision support for national
 key clinical conditions                  e-prescribing and incorporating      high-priority conditions
                                          lab results
 Communicating that information           Electronic transmission of           Patient access to self-management tools
 for care coordination processes          patient care summaries across
                                          multiple settings
 Initiating the reporting of clinical     More patient-controlled data         Access to comprehensive patient data
 quality measures and public                                                   through patient-centered HIE
 health information
 Using information to engage                                                   Improving population health
 patients and their families in
 their care

Source: HealthIT.gov
Figure 3

•	 Data use should focus on patients’ protected                  •	 The need for training and skill development
   health information for research, but their                       in health IT and clinical informatics should
   privacy should be protected in compliance                        be addressed.
   with HIPAA.
•	 Data transparency is a must and should be                     A data analytics framework (see Figure 4) can be
   overseen by a reliable steward.                               used by various stakeholders to not only manage
•	 The initiative should begin by collecting,                    disease treatment but also improve the quality of
   piloting and deploying high-use, high-value                   patient outcomes. However, the security of data
   subsets of data around specific diseases.                     is paramount.
•	 Organizational focus should shift from trans-
   actions to quality and outcomes.



Framework for Analytics

                                                    Health management/
                                                    disease management


                                                                                                Stakeholders (payers,
                                                                                              providers, pharmaceutical
                                                                                                   companies, etc.)
     Security of data                                     Data use

                                                                                                  Quality of outcomes



                                        Application of                   Regulation and
                                         technology                       compliance



Source: Cognizant Research Center
Figure 4


                                        cognizant reports        7
Organizations should adhere to the following best          foresights. These insights should be deliver-
practices:                                                 able across the organization and applica-
                                                           tions. Only then can ana-
•	 Develop a culture that emphasizes fact-                 lytic tools be applied to Both structured
   based decision-making. Available data should            deliver results.             and unstructured
   be structured and analyzed to provide a guide-       •	 Convert most manual
   line for the organization to improve on effi-           data into electronic
                                                                                        data from within
   ciencies and for quick decision-making. The             form. The data from and outside the
   data should be freely available to stakeholders         transactional     systems organization
   who want to use it. A balance must be achieved          should be made avail-
   between data quantity and quality so that phy-          able to those who need
                                                                                        should be
   sicians are not overwhelmed; only relevant              it or could benefit from integrated to build
   insights should be made available to them.              it. Timely availability of a solid information
•	 Provide feedback where required. Most                   information is important,
   clinicians will appreciate a comparative analy-         provided      information
                                                                                        foundation from
   sis with another clinician. If analytics are used       security is given high which to draw
   and the shortcomings are presented in the               priority.                    both insights and
   right format, then an overall improvement in         •	 Evaluate and make sec-
   the outcomes should follow. Clinicians should           ondary use of transac-
                                                                                        foresights.
   be told clearly what they need to change, such          tional data. For example, healthcare organi-
   as the drug administration process or the use           zations should consider revenue-generating
   of testing.                                             partnerships with pharmaceutical companies
•	 Ensure integration of data and greater col-             to leverage their transactional data ethically
   laboration between IT and domain experts.               and ensure mutual benefits for both industry
   Both structured and unstructured data from              segments.
   within and outside the organization should be        •	 Use a pay-per-use model, especially as
   integrated to build a solid information foun-           volumes increase. This would help to variabi-
   dation from which to draw both insights and             lize costs and avoid higher fixed investments.




Footnotes
	 “Work Environment Affects Hospital Readmission Rates,” NursingTimes.net, Dec. 31, 2012,
1

  http://www.nursingtimes.net/nursing-practice/clinical-zones/management/work-environment-affects-
  hospital-readmission-rates/5053171.article.
2
    	 John Commins, “Healthcare Reform Unstoppable, Regardless of Court’s PPACA Decision,”
      HealthLeaders, June 28, 2012, http://www.healthleadersmedia.com/page-2/COM-281759/Healthcare-
      Reform-Unstoppable-Regardless-of-Courts-PPACA-Decision##.
3
    	“Valuing Healthcare: Improving Productivity and Quality,” Kauffman Task Force on Cost-Effective
     Healthcare Innovation, April 2012, http://www.kauffman.org/uploadedfiles/valuing_health_care.pdf.
4
    	“Healthcare Reform: Impact on Hospitals,” Health Capital Consultants, Health Capital Topics, Vol. 4,
     Issue 1, January 2011, http://www.healthcapital.com/hcc/newsletter/1_11/aca.pdf.
5
    	 Rachel Fields, “How Will Healthcare Reform Affect Unnecessary Care,” Becker’s ASC Review,
      May 1, 2012, http://www.beckersasc.com/news-analysis/how-will-healthcare-reform-affect-
      unnecessary-care.html.
6
    	 “Management in Healthcare: Why Good Practice Really Matters,” McKinsey & Co., http://worldmanage-
      mentsurvey.org/wp-content/images/2010/10/Management_in_Healthcare_Report_2010.pdf.




                                  cognizant reports     8
7
 	Kate Spies, “Physician Compensation in U.S. Among Lowest in Western Nations,” Healthcare
  Finance News, May 29, 2012, http://www.healthcarefinancenews.com/news/physician-compensation-
  among-lowest-western-nations.
8
     	 Robert Gelber, “Fixing Healthcare With Big Data,” Datanami, April 4, 2012, http://www.datanami.com/
       datanami/2012-04-04/fixing_healthcare_with_big_data.html.
9
    	 The risk of whether a patient will develop a costly health condition.
10
     	The risk of higher costs from delivering unnecessary services, delivering services inefficiently,
      or committing errors in diagnosis or treatment of a particular condition.
11
    	 “HIPAA, The Privacy Rule and its Application to Health Research,” NCBI, http://www.ncbi.nlm.nih.gov/
      books/NBK9573/.
12
     	“Combating Healthcare Fraud,” SAS, 2010, http://www.sas.com/resources/whitepaper/wp_15046.pdf.
13
     	“The Value of Analytics in Healthcare,” IBM Global Business Services, 2012, http://public.dhe.ibm.com/
      common/ssi/ecm/en/gbe03473usen/GBE03473USEN.PDF.
14
     	 “IBM Uses Watson Analytics to Increase Smartphone, EHR Capabilities,” Healthcare IT News, May 26, 2011,
       http://www.healthcareitnews.com/news/ibm-uses-watson-analytics-increase-smartphone-
       ehr-capabilities.
15
     	Mike Miliard, “Texas Provider Uses Business Analytics Post Treatment Care,” Healthcare IT News,
      March 23, 2011, http://www.healthcareitnews.com/news/texas-provider-uses-business-analytics-
      post-treatment-care.
16
     	Mike Miliard, “Texas Provider Uses Business Analytics Post Treatment Care,” Healthcare IT News,
      March 23, 2011, http://www.healthcareitnews.com/news/texas-provider-uses-business-analytics-post-
      treatment-care.
17
     	Neal Gold, “Three Admissions to Reduce Now,” HealthLeaders, March 15, 2011, http://www.healthlead-
      ersmedia.com/content/COM-263665/3-Readmissions-to-Reduce-Now.html.
18
     	Amy Boutwell, “Time to Get Serious About Hospital Readmissions,” Health Affairs Blog, Oct. 10, 2012,
      http://healthaffairs.org/blog/2012/10/10/time-to-get-serious-about-hospital-readmissions/.
19
     	
     Charles Fiegl, “2,200 Hospitals Face Medicare Penalty for Readmissions,” Amednews.com,
     Aug. 27, 2012,http://www.ama-assn.org/amednews/2012/08/27/gvsb0827.htm.
20
     	 ichelle McNickle, “Five Critical Technologies Health Systems Should Require,” Healthcare IT News,
     M
     July 30, 2012, http://www.healthcareitnews.com/news/5-critical-technologies-health-systems-should-
     require.
21
     	“Needles in a Haystack: Seeking Knowledge with Clinical Informatics,” PricewaterhouseCoopers, 2012,
      http://pwchealth.com/cgi-local/hregister.cgi/reg/needles-in-a-haystack.pdf.
22
     	“Medical Record Documentation for Patient Safety and Physician Defensibility,” MIEC, January 2008,
      http://www.miec.com/Portals/0/pubs/MedicalRec.pdf.
23
     	
     The term “health information exchange” (HIE) refers to electronic sharing of health-related
     information among organizations, with the goal of reducing duplication of services and operational
     costs for healthcare providers.
24
     	
     Gabriel Perna, “PwC Report: With Population Health, Payers and Providers Have to Play Nice,”
     Healthcare IT News, Sept. 28, 2012, http://www.healthcare-informatics.com/article/pwc-report-popula-
     tion-health-payers-and-providers-have-play-nice.




                                    cognizant reports      9
25
     	
     “Aetna and Baycare to Introduce Collaborative Care in Tampa,” Aetna News Hub, Dec. 17, 2012,
     http://newshub.aetna.com/press-release/health-care-professionals-and-networks/aetna-and-baycare-
     introduce-collaborative-care-.
26
  	
  “Ready or Not: On the Road to Meaningful Use of EHRs and Health IT,” PricewaterhouseCoopers,
  June 2010, http://pwchealth.com/cgi-local/hregister.cgi/reg/Ready-or-not-On-the-road-to-meaning-
  ful-use-of-EHRs-and-health-IT.pdf.




Credits

Authors

Sanjay Fuloria, Ph.D., Senior Researcher, Cognizant Research Center
Yuvaraj Velusamy, Researcher, Cognizant Research Center




Design

Harleen Bhatia, Creative Director
Chiranjeevi Manthri, Designer



About Cognizant

Cognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process
outsourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered
in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep in-
dustry and business process expertise, and a global, collaborative workforce that embodies the future of work. With
over 50 delivery centers worldwide and approximately 150,400 employees as of September 30, 2012, Cognizant is a
member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the
top performing and fastest growing companies in the world.

Visit us online at www.cognizant.com for more information.



                                        World Headquarters                   European Headquarters                India Operations Headquarters
                                        500 Frank W. Burr Blvd.              1 Kingdom Street                     #5/535, Old Mahabalipuram Road
                                        Teaneck, NJ 07666 USA                Paddington Central                   Okkiyam Pettai, Thoraipakkam
                                        Phone: +1 201 801 0233               London W2 6BD                        Chennai, 600 096 India
                                        Fax: +1 201 801 0243                 Phone: +44 (0) 207 297 7600          Phone: +91 (0) 44 4209 6000
                                        Toll Free: +1 888 937 3277           Fax: +44 (0) 207 121 0102            Fax: +91 (0) 44 4209 6060
                                        Email: inquiry@cognizant.com         Email: infouk@cognizant.com          Email: inquiryindia@cognizant.com


©
­­ Copyright 2013, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is
subject to change without notice. All other trademarks mentioned herein are the property of their respective owners.

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Analytics-Driven Healthcare: Improving Care, Compliance and Cost

  • 1. • Cognizant Reports Analytics-Driven Healthcare: Improving Care, Compliance and Cost In the face of skyrocketing costs, the healthcare industry is addressing inefficiencies by improving data sharing and collaboration across the industry value chain and applying analytics to improve operations and patient outcomes. Executive Summary health conditions and prescriptions, while semi- Ever-increasing costs highlight the inefficiencies structured and unstructured data is available in that currently plague each link in the U.S. health- e-mail, social networking sites, doctors’ notes, care industry’s value chain. If deployed properly, test results, physicians’ commentaries, etc. The advanced analytics can play a significant role integration of all this data is key, and this calls for in reducing these inefficiencies and providing greater collaboration among the IT departments healthcare organizations with insights to manage of healthcare organizations, care practitioners their business more proactively and profitably. and claims processing experts. For example, analysis of electronic health To fully exploit this abundance of data, health- record (EHR) data can lead to improved clinical care organization must create a culture that outcomes and reduced readmissions, both of places a premium on fact-based planning and which can lower costs and inspire patient loyalty. decision-making. Evidence-based insights from This will become particularly important this a variety of sources can be used to provide year, when hospital readmissions — which cost valuable feedback to physicians. Medicare $15 billion in 20121 — will begin to be penalized by the U.S. Centers for Medicare & Furthermore, as data volumes rise, a “pay-per- Medicaid Services (CMS). use” analytics model will help minimize costs for healthcare organizations, large and small. Analytics, moreover, can help predict an individual’s future healthcare needs, which can be Rising Healthcare Costs, valuable for both the payer and provider. Health- Regulatory Pressures care organizations must, therefore, begin to set Healthcare costs in the U.S. are ballooning. up internal systems that gather disparate data The annual spend in 2012 was estimated at in one place. This includes both structured around $3 trillion, or about 20% of the GDP. and unstructured data; for example, EHR pro- This expenditure is twice that of any other vides structured data of a patient’s history of industrialized country. What’s more, costs will cognizant reports | february 2013
  • 2. increase by a projected 4% to 6% in 2013, mortality rate for acute myocardial infarction which is more than the estimated 2.3% rate of (AMI) decreases by 7%. Moreover, the EBITDA inflation.2 Despite technology and process improve- per bed increases by 14%, and the percentage of ments, it is widely believed that the U.S. health- individuals who would recommend the hospital care industry remains highly inefficient due to a increases by 0.8%. lack of shared insights, collaboration, incentives for cost control and quality healthcare research. Excessive compensation for physicians also In fact, it is estimated that around $700 billion of contributes to skyrocketing costs. Physician the $2.5 trillion spent on healthcare in 2010 in the salaries in the U.S. account for 8.6% of total U.S. represents unnecessary expenditures.3 healthcare costs. In absolute dollar terms, U.S. physicians earn more than physicians of Relief may be on the way. Federal regula- other nations, as the average per capita health- tions mandating better health outcomes are care spend in the U.S. is $2,600 more than the pressuring the industry to become more efficient. next highest spending country.7 The Patient Protection and Affordable Care Act (PPACA), for example, addresses the twin goals Deploying Analytics of reducing healthcare costs and improving In this scenario of runaway healthcare costs — as quality of patient care. It clearly ties reimburse- well as growing regulatory pressure for affordability ments to the performance of healthcare organi- and improvement in clinical outcomes — analytics zations. A percentage of these reimbursements has emerged as a silver bullet for the healthcare will take into consideration the efficiency of the industry. Analytics can generate insights that healthcare organization, as well as patient satis- lower costs, reduce inefficiencies, identify at-risk faction metrics.4 populations, predict individuals’ future health- care needs and support physicians’ diagnoses. Unnecessary procedures are one cause of the Analytics can enable more efficient use of cost spike. According to a survey published by resources by ensuring that those who need care Archives of Internal Medicine, 43% of respon- the most receive it. dents said many patients are asked to undergo unnecessary tests by physicians.5 In short, analytics can be used to: According to a McKinsey report,6 effective • Build multidimensional predictive models. hospital management strongly correlates with • Reduce costs. high-quality care. When the quality of hospi- • Improve outcomes. tal management improves by one unit on a • Empower patients. scale of 1 (worst) to 5 (best), the report says, the Multidimensional Predictive Models Today’s Industry Model Future State Care Management Identification Care Management Identification Convergence of health and nonhealth insights Medical Health-based Third-party claims data member consumer insights insights Health Health- assessment Multi-dimensional Pharmacy based data Stratification member insights claims data member Predictive and care insights modeling outreach Predictive modeling Wellness Health Outcome Goals screening activity data Stratification • Higher engagement data care • Improved health outreach • Reduced healthcare costs Source: "The Promise of Healthcare Analytics," Healthleaders Media, 2012. Figure 1 cognizant reports 2
  • 3. Multidimensional Predictive Models short-count pills and fill prescriptions without a Prior to the signing of the PPACA into law refill and then overbill Medicaid. in 2010, payers and providers disagreed on accountability for controlling healthcare costs. Such fraud can be reduced by using rule-based Today, both parties agree they must work algorithms.12 For instance, on the payer side of the collaboratively and share accountability for the healthcare equation, a business rule might ask total cost of care. Therefore, information about for closer inspection of a claim when it exceeds patient health is increasingly being combined a benchmark dollar amount. Similarly, an alarm with nonhealth information and third-party could be triggered if multiple medical proce- consumer insights to create multidimensional dure codes are used instead of a single code or predictive models. These models lead to better if a claimant submits an unusually high number stratification that, in turn, leads to higher engage- of claims. ment, improved health and reduced healthcare costs (see Figure 1, previous page). Lack of access to healthcare also contributes to industry inefficiency, as the need for services is Reducing Costs sometimes greater than the healthcare resources Because healthcare services come with a price, available. The decision to provide a service should organizations are incentivized to seek volume be driven by the relative merit of the patient’s over value. This model encourages repeat visits need. Surplus resources can then be made avail- to healthcare providers, readmissions and other able to those who really need them. Analytical inefficiencies that increase costs. Analytics can models can be built on the basis of demographic be used to implement a payment method based characteristics to inform this decision-making on performance, where instead of volume, the process, thus increasing access to healthcare to provider would be paid for value, as determined those most in need.13 by outcomes.8 Improving Outcomes This model can be achieved by structuring the The healthcare industry across the globe is payment system so that the payer assumes the moving from volume to value. As such, clinical “insurance risk”9 and the provider assumes the outcomes are more impor- “performance risk.”10 Providers can then use tant than ever. Healthcare An evidence- available patient data to deliver better solutions industry-related data is based approach that are focused more on outcomes and value increasing at a rate of 35% than on volume of patient care. per year due to increased to collecting use of EHR capabilities and and analyzing Additionally, the Health Insurance Portability other forms of unstructured information from and Accountability Act’s (HIPAA) privacy rules data generated by social permit the disclosure of protected health infor- Web site and mobile device various sources mation (PHI) for research without the authori- usage. Advanced analytics can be employed to zation of the individual.11 Data-driven models are can help organizations more enable appropriate being used to identify disease risk factors. By effectively mine this data to using these models to identify at-risk populations, improve health outcomes.14 intervention for the providers can initiate treatment earlier, thus Additionally, an evidence- physician at the reducing costs. In fact, early diagnoses often lead based approach to collecting point of care. to treatments that use less expensive medicines and analyzing information or no medicine at all. from various sources can be employed — including practitioner research papers, technical reports, Fraud committed by healthcare provider person- clinical trial studies, expert views, patient charac- nel is another cause of growing costs. Such fraud teristics, etc. — to enable appropriate intervention can take the form of duplicate scripts or filling for the physician at the point of care. multiple prescriptions for the same drug. These activities increase revenue for the provider and Minimizing Readmissions unintentionally create incentives for employ- Nearly one in five Medicare patients in the ees to commit fraud. For example, employees U.S. is readmitted within 30 days of hospitaliza- can substitute generic drugs for brand names, tion.15 Healthcare providers are increasingly using cognizant reports 3
  • 4. advanced analytics to improve after-treatment among the use cases in which advanced analyt- care by gaining insights into treatment trends ics can drive thoughtful and effective preventive and causes for readmission and designing inter- care strategies. ventions. A leading U.S. healthcare provider has In an increasingly reduced readmissions by 22% through the use of Educating patients about analytics.16 their health conditions and competitive taking precautionary mea- world, where Beginning in 2013, CMS will begin penalizing sures will also help health- reimbursements providers for readmissions beyond a stated care providers establish cut-off for some conditions.17 Total penalties preventive care initiatives. are declining and for 2013 are estimated to reach $280 million.18 Effectively disseminat- proof of better Hospitals that fail to show readmission rate ing information through care is required improvements will be penalized up to 2% of patients’ preferred chan- Medicare reimbursements in 2014 and 3% in nels is vital to encouraging to improve 2015.19 Moreover, more chronic conditions will them to access requisite clinical outcomes, be included on the readmission penalty list in information about their organizations need the future, including cardiac bypass surgery conditions and share pre- and chronic obstructive pulmonary disease. ventive measures. With to analyze all the Analytics can be used on the EHR data of patients increasing use of smart- data they can get with chronic conditions, as well as other discharge phones, mobile applications their hands on. procedures, to identify the target population and can be used to educate enhance patient monitoring with appropriate patients and for outreach. These applications can post-discharge plans that reduce readmissions. help access physician guidelines and share health information, such as sugar levels and blood It is, therefore, imperative for healthcareorgani- pressure levels. The key here is providing zations to prepare and understand their readmis- accessibility to portals through smartphones. sion metrics, calculate their readmission rates by condition and physical performance and com- Health information wellness calculators should pare outcomes with benchmark rates. This is a also be accessible on-the-go.20 These wellness highly data-intensive analytical process that will calculators can help determine average walking benefit healthcare providers by reducing penal- speed, stride length, calories burned by activity, ties or, better yet, avoiding them. Providers can resting metabolism and also body fat percentage also use patients’ demographic data to conduct (see sidebar, next page). Once these details are a risk assessment, identify at-risk patients and obtained, an individual can decide whether it’s prioritize their treatment. necessary to contact a physician. Moreover, this unstructured data is ripe for predictive analysis Preventive Care that can help improve patient outcomes and lead to Historically, healthcare has been considered better management of the healthcare ecosystem. a local service, and comparing it with related geographic markets was considered unnecessary. Significant data is available on the payer side, It was not price sensitive or driven by market as well. Predicting patients’ future healthcare needs, so operational analysis was considered needs would greatly benefit at-risk patients. a waste of resources. Even if it were important, For one leading payer, 4% of customers account healthcare institutions either lacked appropriate for 50% of its cost. If the insurer could identify technology or were saddled with outdated IT sys- and engage that small customer segment to tems that in many cases did not offer data analysis better manage their health, it could improve not only capabilities. cost control but its healthcare outcomes, as well. However, in an increasingly competitive world, Empowering Patients where reimbursements are declining and proof Consumers can and should become more respon- of better care is required to improve clinical sible for their own health if they are provided with outcomes, organizations need to analyze all the more relevant and timely data-driven insights. data they can get their hands on. Stratifying the They can, for instance, select the best provider population, identifying patients at risk, analyzing in their vicinity by examining a report card on gaps in care and elevating pre-care planning are various institutions. Customer relationship cognizant reports 4
  • 5. management and marketing techniques used In a survey of 263 healthcare professionals, in retail can also be emulated to understand 71% of respondents cited data integration appropriate communication channels for patients from multiple sources as a main goal, while to disseminate the right message at the right 56% indicated data standardization was a top time. For instance, a monitoring system is avail- priority. More than 8 in 10 (86%) said these able that monitors a medication prescribed for goals were difficult to achieve.21 The standard- diabetes patients at prescribed intervals and ization problem is clearly visible in physician sends text messages or makes phone calls as a notes,22 as their descriptive narratives can be therapeutic reminder. difficult to analyze. Techniques such as natural language processing (NLP) can help mine criti- Data Standardization, Integration and cal details from such unstructured data. Collaboration Challenges While there are many possible benefits to be • Lack of collaboration across the health- obtained using analytics, challenges remain, care value chain: Most organizations con- including the following: sider the data they generate to be proprietary and sacrosanct and are, therefore, unwilling • Lack of data integration and poor standard- to share that data with other stakeholders. ization: Historically, healthcare organizations EHR vendors have built data warehouses have lamented the insufficient funds available and are beginning to share masked patient for IT investment. Now, the issue is a lack of stan- data with their clients. For the accountable dardization and nonexistent data integration. care organization model to be successful, Quick Take Mobilizing Via M-Health Helping consumers and patients fill an active role in healthcare is an essential component of the new healthcare business model. The explosion of mobile devices and apps dovetails with this requirement. Mobile health, or “m-health,” fulfills two key needs: enabling consumers to manage their health service relationships more easily and giving individuals powerful portable tools for managing chronic conditions and staying well. One application we have developed at our clients’ request will allow consumers to easily manage their health plans from a variety of computing platforms, including smartphones and tablets. The app enables them to search for providers, receive immediate explanation of benefits notices, get messages about coverage changes, obtain a secure ID card for use at physician offices and emergency departments, and use a variety of ease-of-use features, such as click-to-call. Another app offers personalized wellness management via smartphone or tablet. This app enables patients and members to easily enter or auto- matically download health information, such as blood pressure, blood sugar, cholesterol levels, weight, body measurements, etc. Then, in easy-to-read charts, the app shows them how their current results relate to their goals and offers a variety of tips and information to help them achieve those goals. Authorized physicians may access data from the app to monitor patient progress more frequently, with- out the time or expense of office visits. Plans and physicians may also customize the app to be alerted to changes in a patient’s condition that require intervention. Employers may even use the app in wellness campaigns, with games and graphics encouraging participation. The objective of these features is to prevent minor conditions from escalating to more serious problems that cost more to treat and manage. Apps like these will put health management tools literally at the fingertips of consumers and patients, giving them the more active role in their health choices they are demanding – and that will help reshape healthcare. This article originally appeared in Cognizanti Journal, Volume 5, Issue 1, 2012. cognizant reports 5
  • 6. increased collaboration and sharing of patient The Way Forward information among different healthcare Funding from the government for EHRs will be providers should become a wider practice. made available only to organizations that meet the proposed CMS criteria for the meaningful Other players see analytics as a com- use of EHR (see Figure 3, next page). Healthcare mercial opportunity. Organizations with providers were mandated by CMS to begin analytics expertise offer their services to capturing and sharing data in 2011-12. Provid- health information exchanges23 to improve the ers need to use advanced care processes with quality of information and outcome of care. decision support in 2014 and show improved Pharmaceuticals companies and the research outcomes by 2016. If these criteria are not met, arms of insurers have aligned to explore their reimbursements from Medicare will be ways to improve the health of the elderly and reduced.26 individuals with chronic conditions. Payers have rich sources of information on claims The resulting decision support systems will be with disease codes from patients admitted based on analytics that take health information to different clinics and other administrative from the established EHR and other health IT information. If this data could be combined systems and apply statistical/artificial intelligence with the patient information generated by techniques to identify various risk factors, strat- providers, it could provide a wealth of action- ify patients based on health conditions, provide able insights. actionable information to physicians at the point of care and measure progress on health outcomes. Kaiser, an integrated provider and payer, for example, was able to reduce 30-day readmis- Given that healthcare organizations can reap sion rates at one of its medical centers from multiple benefits from using analytics, it is 13.6% to 9% in six months by using a collab- imperative that they create an environment orative payer/provider approach.24 Aetna, one conducive to nurturing this capability. They must of the largest private insurers, partnered with create a knowledge- and analytics-driven culture BayCare health system to improve manage- that pervades the entire organization. In fact, ment of patients with chronic conditions such all clinical information stored in standard data as diabetes and heart failure, as well as reduce formats such as EHRs must be captured and trans- readmission costs.25 formed into actionable data on which analytics can be applied. The following principles should be Other challenges include limited access to skills considered when building a framework for data and resources, the lack of a clear vision on the use across the healthcare industry: benefits of analytics, and limited funding and management support for analytics (see Figure 2). Challenges of Analytics Use 60 Poor data quality: Diverse data sources makes it 52.2% difficult to create a single source of the truth 48.3% Limited access to skills and resources 50 43.5% Information is not available in a timely manner, 39.7% so decisions are made without being data driven 40 39.2% Limited analytics champion/sponsorship Lack of a clear vision on how the organization 27.3% can benefit from analytics 30 26.8% Poor data: Too many manual systems deployed, resulting in insufficient electronic data 20 16.3% Poor data: Transactional systems exist, but data cannot be unlocked easily 10 6.7% Culture not ready to become a data-driven organization 0 Other Source: "Business Intelligence/Analytics Survey," Healthcare IT News, February 2012. Figure 2 cognizant reports 6
  • 7. CMS Criteria for Meaningful Use of EHR Stage 1 Stage 2 Stage 3 2011-2012 2014 2016 Data capture and sharing Advanced clinical processes Improved outcomes Electronically capturing health More rigorous health information Improving quality, safety and efficiency, information in a standardized exchange leading to improved health outcomes format Using that information to track Increased requirements for Decision support for national key clinical conditions e-prescribing and incorporating high-priority conditions lab results Communicating that information Electronic transmission of Patient access to self-management tools for care coordination processes patient care summaries across multiple settings Initiating the reporting of clinical More patient-controlled data Access to comprehensive patient data quality measures and public through patient-centered HIE health information Using information to engage Improving population health patients and their families in their care Source: HealthIT.gov Figure 3 • Data use should focus on patients’ protected • The need for training and skill development health information for research, but their in health IT and clinical informatics should privacy should be protected in compliance be addressed. with HIPAA. • Data transparency is a must and should be A data analytics framework (see Figure 4) can be overseen by a reliable steward. used by various stakeholders to not only manage • The initiative should begin by collecting, disease treatment but also improve the quality of piloting and deploying high-use, high-value patient outcomes. However, the security of data subsets of data around specific diseases. is paramount. • Organizational focus should shift from trans- actions to quality and outcomes. Framework for Analytics Health management/ disease management Stakeholders (payers, providers, pharmaceutical companies, etc.) Security of data Data use Quality of outcomes Application of Regulation and technology compliance Source: Cognizant Research Center Figure 4 cognizant reports 7
  • 8. Organizations should adhere to the following best foresights. These insights should be deliver- practices: able across the organization and applica- tions. Only then can ana- • Develop a culture that emphasizes fact- lytic tools be applied to Both structured based decision-making. Available data should deliver results. and unstructured be structured and analyzed to provide a guide- • Convert most manual line for the organization to improve on effi- data into electronic data from within ciencies and for quick decision-making. The form. The data from and outside the data should be freely available to stakeholders transactional systems organization who want to use it. A balance must be achieved should be made avail- between data quantity and quality so that phy- able to those who need should be sicians are not overwhelmed; only relevant it or could benefit from integrated to build insights should be made available to them. it. Timely availability of a solid information • Provide feedback where required. Most information is important, clinicians will appreciate a comparative analy- provided information foundation from sis with another clinician. If analytics are used security is given high which to draw and the shortcomings are presented in the priority. both insights and right format, then an overall improvement in • Evaluate and make sec- the outcomes should follow. Clinicians should ondary use of transac- foresights. be told clearly what they need to change, such tional data. For example, healthcare organi- as the drug administration process or the use zations should consider revenue-generating of testing. partnerships with pharmaceutical companies • Ensure integration of data and greater col- to leverage their transactional data ethically laboration between IT and domain experts. and ensure mutual benefits for both industry Both structured and unstructured data from segments. within and outside the organization should be • Use a pay-per-use model, especially as integrated to build a solid information foun- volumes increase. This would help to variabi- dation from which to draw both insights and lize costs and avoid higher fixed investments. Footnotes “Work Environment Affects Hospital Readmission Rates,” NursingTimes.net, Dec. 31, 2012, 1 http://www.nursingtimes.net/nursing-practice/clinical-zones/management/work-environment-affects- hospital-readmission-rates/5053171.article. 2 John Commins, “Healthcare Reform Unstoppable, Regardless of Court’s PPACA Decision,” HealthLeaders, June 28, 2012, http://www.healthleadersmedia.com/page-2/COM-281759/Healthcare- Reform-Unstoppable-Regardless-of-Courts-PPACA-Decision##. 3 “Valuing Healthcare: Improving Productivity and Quality,” Kauffman Task Force on Cost-Effective Healthcare Innovation, April 2012, http://www.kauffman.org/uploadedfiles/valuing_health_care.pdf. 4 “Healthcare Reform: Impact on Hospitals,” Health Capital Consultants, Health Capital Topics, Vol. 4, Issue 1, January 2011, http://www.healthcapital.com/hcc/newsletter/1_11/aca.pdf. 5 Rachel Fields, “How Will Healthcare Reform Affect Unnecessary Care,” Becker’s ASC Review, May 1, 2012, http://www.beckersasc.com/news-analysis/how-will-healthcare-reform-affect- unnecessary-care.html. 6 “Management in Healthcare: Why Good Practice Really Matters,” McKinsey & Co., http://worldmanage- mentsurvey.org/wp-content/images/2010/10/Management_in_Healthcare_Report_2010.pdf. cognizant reports 8
  • 9. 7 Kate Spies, “Physician Compensation in U.S. Among Lowest in Western Nations,” Healthcare Finance News, May 29, 2012, http://www.healthcarefinancenews.com/news/physician-compensation- among-lowest-western-nations. 8 Robert Gelber, “Fixing Healthcare With Big Data,” Datanami, April 4, 2012, http://www.datanami.com/ datanami/2012-04-04/fixing_healthcare_with_big_data.html. 9 The risk of whether a patient will develop a costly health condition. 10 The risk of higher costs from delivering unnecessary services, delivering services inefficiently, or committing errors in diagnosis or treatment of a particular condition. 11 “HIPAA, The Privacy Rule and its Application to Health Research,” NCBI, http://www.ncbi.nlm.nih.gov/ books/NBK9573/. 12 “Combating Healthcare Fraud,” SAS, 2010, http://www.sas.com/resources/whitepaper/wp_15046.pdf. 13 “The Value of Analytics in Healthcare,” IBM Global Business Services, 2012, http://public.dhe.ibm.com/ common/ssi/ecm/en/gbe03473usen/GBE03473USEN.PDF. 14 “IBM Uses Watson Analytics to Increase Smartphone, EHR Capabilities,” Healthcare IT News, May 26, 2011, http://www.healthcareitnews.com/news/ibm-uses-watson-analytics-increase-smartphone- ehr-capabilities. 15 Mike Miliard, “Texas Provider Uses Business Analytics Post Treatment Care,” Healthcare IT News, March 23, 2011, http://www.healthcareitnews.com/news/texas-provider-uses-business-analytics- post-treatment-care. 16 Mike Miliard, “Texas Provider Uses Business Analytics Post Treatment Care,” Healthcare IT News, March 23, 2011, http://www.healthcareitnews.com/news/texas-provider-uses-business-analytics-post- treatment-care. 17 Neal Gold, “Three Admissions to Reduce Now,” HealthLeaders, March 15, 2011, http://www.healthlead- ersmedia.com/content/COM-263665/3-Readmissions-to-Reduce-Now.html. 18 Amy Boutwell, “Time to Get Serious About Hospital Readmissions,” Health Affairs Blog, Oct. 10, 2012, http://healthaffairs.org/blog/2012/10/10/time-to-get-serious-about-hospital-readmissions/. 19 Charles Fiegl, “2,200 Hospitals Face Medicare Penalty for Readmissions,” Amednews.com, Aug. 27, 2012,http://www.ama-assn.org/amednews/2012/08/27/gvsb0827.htm. 20 ichelle McNickle, “Five Critical Technologies Health Systems Should Require,” Healthcare IT News, M July 30, 2012, http://www.healthcareitnews.com/news/5-critical-technologies-health-systems-should- require. 21 “Needles in a Haystack: Seeking Knowledge with Clinical Informatics,” PricewaterhouseCoopers, 2012, http://pwchealth.com/cgi-local/hregister.cgi/reg/needles-in-a-haystack.pdf. 22 “Medical Record Documentation for Patient Safety and Physician Defensibility,” MIEC, January 2008, http://www.miec.com/Portals/0/pubs/MedicalRec.pdf. 23 The term “health information exchange” (HIE) refers to electronic sharing of health-related information among organizations, with the goal of reducing duplication of services and operational costs for healthcare providers. 24 Gabriel Perna, “PwC Report: With Population Health, Payers and Providers Have to Play Nice,” Healthcare IT News, Sept. 28, 2012, http://www.healthcare-informatics.com/article/pwc-report-popula- tion-health-payers-and-providers-have-play-nice. cognizant reports 9
  • 10. 25 “Aetna and Baycare to Introduce Collaborative Care in Tampa,” Aetna News Hub, Dec. 17, 2012, http://newshub.aetna.com/press-release/health-care-professionals-and-networks/aetna-and-baycare- introduce-collaborative-care-. 26 “Ready or Not: On the Road to Meaningful Use of EHRs and Health IT,” PricewaterhouseCoopers, June 2010, http://pwchealth.com/cgi-local/hregister.cgi/reg/Ready-or-not-On-the-road-to-meaning- ful-use-of-EHRs-and-health-IT.pdf. Credits Authors Sanjay Fuloria, Ph.D., Senior Researcher, Cognizant Research Center Yuvaraj Velusamy, Researcher, Cognizant Research Center Design Harleen Bhatia, Creative Director Chiranjeevi Manthri, Designer About Cognizant Cognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process outsourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep in- dustry and business process expertise, and a global, collaborative workforce that embodies the future of work. With over 50 delivery centers worldwide and approximately 150,400 employees as of September 30, 2012, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world. Visit us online at www.cognizant.com for more information. World Headquarters European Headquarters India Operations Headquarters 500 Frank W. Burr Blvd. 1 Kingdom Street #5/535, Old Mahabalipuram Road Teaneck, NJ 07666 USA Paddington Central Okkiyam Pettai, Thoraipakkam Phone: +1 201 801 0233 London W2 6BD Chennai, 600 096 India Fax: +1 201 801 0243 Phone: +44 (0) 207 297 7600 Phone: +91 (0) 44 4209 6000 Toll Free: +1 888 937 3277 Fax: +44 (0) 207 121 0102 Fax: +91 (0) 44 4209 6060 Email: inquiry@cognizant.com Email: infouk@cognizant.com Email: inquiryindia@cognizant.com © ­­ Copyright 2013, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners.