Health systems have an important opportunity—one that they should not miss—to use big data to help optimize performance, reduce risk, and increase profits.


But performance transparency to a health system can mean many different things. It can mean how a physician assesses his or her own outcomes. It can mean how a health system understands why it is losing patients—and to which competitors. It can mean the ability to mitigate risks and optimize revenue. In this new world of big data, performance transparency has value even when it doesn’t directly reach the patient.

By shifting focus to performance transparency, a health system can better analyze and understand what happens within its walls and within the community it serves. Performance transparency can increase patient loyalty, improve patient care, and inspire the kind of fact-based creative thinking that identifies efficiencies while improving outcomes.

Using Performance Transparency to Increase Revenue and Improve Patient Experience

The use of big data to evaluate and communicate physician performance transparency enables health systems to improve the patient experience, function more efficiently, and increase patient conversions, all while delivering better care. To better understand how, let’s start where a health system’s patients start: with the call center.

Health systems spend millions of dollars to drive potential patients to their call centers, but all too often, calls fail to convert to appointments and revenue. Call center agents must rely upon antiquated technology and often refer patients to providers without knowing a physician’s particular expertise, outcomes, or availability. The result is frustrated patients, incomplete calls, and failed conversions to appointments.

By contrast, call center agents who have a deep transparent view into a health system’s clinical resources and capabilities can direct patients to the most appropriate providers for them. A caller with a torn meniscus, for instance, doesn’t want a list of 45 orthopedic surgeons. The caller wants to know which surgeons on a hospital’s roster specialize in the particular condition, and which of those surgeons have demonstrated the best outcomes, the shortest recovery times, and have the most immediate availability.

A health system with a call center that drills deep into a hospital’s roster to deliver that level of information is in a strong position to turn callers into patients—and to begin lifelong relationships with patients stretching well beyond the initial need.

In addition to strengthening call centers, the use of big data to provide performance transparency can move health systems’ websites toward the consumer-oriented model that patients have come to expect of all their online experiences.

For example, today, prospective homebuyers can take virtual tours and harried parents can have diapers delivered to their doorsteps. Potential buyers can easily find everything they want to know about a car—from safety to comfort and performance—secure a loan, and make a purchase with nothing more than their fingers and a phone. Health systems, by comparison, are generally lagging in this area.

In fact, a recent report issued by the global professional services company Accenture found that less than 10 percent of U.S. health systems currently offer patients the ability to digitally self-schedule.a With Google Think surveys finding that 76 percent of patients begin their healthcare research on hospital websites, this limitation of these websites represents an enormous lost opportunity.b

Imagine the airline industry operating this way. Before booking a flight, you’d have to call to find out if the airline flies to a certain location, when flights are scheduled, if any seats are available, and how much a ticket costs. You’d then have to repeat this several times before finding the right airline and booking a flight. That sounds aggravating and time-consuming, but it is exactly how consumers view finding physicians and booking appointments.

Integrating real-time information about providers’ availability on health system websites can turn those websites into scheduling tools, helping patients to find the right physician and empowering them to make their own appointments on mobile devices and desktops. This level of transparency can significantly improve conversion rates and relieve the burden on the call center, further enabling call center agents to provide a better patient experience.

Using Performance Transparency to Reduce Risk

The Affordable Care Act (ACA) has promoted increased participation in accountable care organizations (ACOs), with the aim of improving the safety and quality of care while reducing costs. The goal of an ACO is to deliver seamless, high-quality care by creating a value-based payment model that holds providers financially accountable for the cost and quality of care they deliver. But a key consideration for a health system that participates in an ACO is knowing which physicians to include in the ACO and which ones to not include.

Because the health system is taking financial risk based on the performance of its physicians in the ACO, it is critical to select the best-performing physicians—but how? Health systems struggle to measure physician performance, especially from a financial efficiency point of view. Using physician performance transparency, health systems can solve this problem by evaluating physicians’ performance using outcomes as well as cost and efficiency. Then, physicians can be compared, decisions made, and ACO selections finalized, all while giving the health system confidence that it has made a solid financial decision.

Using big data to achieve performance transparency offers a consistent solution for measuring quality and helps health systems identify which physicians present the greatest probability of producing positive clinical outcomes.

The need for such a solution couldn’t be greater.

Half of providers responding to a recent survey by the Health Care Advisory Board said they anticipate that at least 50 percent of their business will come from risk-based contracts in the next three years, such as an ACO or managed care organization.c As more health systems wade into these uncharted waters, this change will drive narrow networks to align with the highest-quality providers.

At the same time, many health systems also are seeking to increase market share by expanding geographically and adding new physicians. With each of these ventures, health systems increase the potential for revenue, but they also take on additional risk.

By tapping into performance information, health systems are now able to evaluate how the performance of individual physicians, groups of physicians, and centers of excellence stacks up against that of their peers. And by analyzing key performance markers, such as readmission rates, post-surgical complication rates, and length of stay, a health system can pinpoint high-cost, high-risk performance areas that need to be addressed.

For example, one health system could benchmark its orthopedic department against its main competitors, specifically looking at surgical outcomes and quality. By using physician performance data, the health system could identify how its quality and outcomes stack up. Does it have lower complication rates or readmission rates? Shorter lengths of stay? This performance information then can be immediately leveraged by marketing to help differentiate the health system as a higher-quality facility, making it more attractive to prospective patients. Without the data, such differentiation is difficult.

For instance, patients who are treated by inexperienced physicians are more likely to experience poorer outcomes and longer hospital stays than are patients cared for by physicians with more expertise and proficiency. But determining experience can be tricky. A neurosurgeon who has been out of medical school for 20 years is not necessarily more experienced at pituitary tumor surgery—a very rare type of surgery—than a younger physician who specializes in this particular field. By using physician performance data showing the actual number of times each physician has performed each procedure over the past 10 years, patients can be matched with the physicians who have the demonstrated experience in this particular area.

Big data can capture each physician’s share of practice and total experience for any given procedure. Such a data combination serves as the most concrete proof of experience, and the most useful solution for health systems and for patients hoping to find the physicians that can best meet their needs.

This type of performance transparency helps ensure patients are referred to the most appropriate physicians and gives providers increased opportunities to shine at what they do best—and equally important, it allows health systems to make better decisions about which physicians to add to their rosters, and which ACOs to add to their groups.

Using Performance Transparency to Modify Behavior

Performance data also can help uncover procedural problems within a hospital and health system and target simple and cost-effective systemic improvements. Possible solutions include implementing checklists for physicians or teams whose error rates are higher than average and enforcing the hospital’s hand-washing program for those groups who are seeing an increase in infection rates.

Such small moves can result in enormous benefits both to hospital costs and to patient health: Approximately 80,000 people in the United States die every year from hospital-acquired illnesses.d This situation is not only tragic but also preventable, and performance transparency can serve as the key to help identify those areas in a hospital system that could benefit from incentive programs and strong reminders.

Moreover, by providing a means for evaluating physician practices across different health systems, performance transparency provides unprecedented insight into where patients go for follow-up care. By looking for patterns in patient migration, performance transparency tools allow health systems to fix a problem vexing all hospitals today: loss of patients.

Looking at big data, for example, health systems now can see that one of the reasons patients seek other providers for follow-up care is that they are following their physician’s orders. More than one-third of U.S. patients are referred to specialists each year, with the bulk of those patients relying on their primary care physicians for advice about whom to see. Unfortunately, as primary care practices are acquired or new physicians are brought on board, these physicians often don’t have the institutional knowledge they need to keep referrals within their health system.

Transparency allows a health system to uncover outside referrals, educate providers, and reduce patient leakage. Moreover, by helping to retain patients within the health system, it also will result in a welcome change for these patients, who can benefit from the convenience and continuity of care inherent in staying within one health system.

If patients are leaving a health system because it does not deliver the care the patients require, transparency will identify that problem, too. Information about where patients go for care can be enormously instructive to help health systems identify areas that are missing or programs whose quality needs beefing up relative to the competition. Referral data of this type are available from third parties that track physician performance outside of a health system’s four walls, enabling the organization to get an entirely new view of the market, beyond its own data.

Using Performance Transparency to Improve Care

Patients want the best physicians for their particular conditions, and physicians want to be the best providers for their patients. Performance transparency empowers patients to choose the most appropriate providers, and it informs physicians about the quality of the care they give. A meaningful evaluation of performance with transparency, therefore, can help improve patient outcomes, avoid costly readmissions, and mitigate other costs. Unfortunately, performance data are not always made available internally.

Physician quality performance data tend to be shrouded in secrecy, in all likelihood because it all too often is thought to be punitive. A bad online review or a journalistic hit-piece is rolled into the same category as fact-based performance quality data. This situation is unfortunate, because factual performance data can be inordinately helpful to physicians.

Performance transparency allows physicians to better understand and improve their own outcomes. Like a football player watching footage of plays post-game, performance transparency allows a provider to appreciate his or her strengths and visualize what needs improving. And in creating opportunities for physicians to review their performance, hospital leaders can reinforce this idea with physicians and encourage them to view the data as a valuable tool for self evaluation.

Performance transparency also gives both the physician and the health system a better understanding of what is happening after patients receive treatment that can make a significant difference in terms of quality and cost. If a physician sees lower-than-average postsurgical infection rates, for instance, what is he or she doing that others can learn from to reduce their rates, as well? If another physician is seeing higher-than-average readmission rates for one particular procedure, what steps or continuing education programs might help improve outcomes?

Ultimately, everything in health care comes down to the patients, and performance transparency is no exception. Before placing their health and wellness, and often their lives, in the hands of any given physician, patients want to know as much as possible about the physician and the treatment they will undergo.

At this time, not much information is available. Some websites list a physician’s educational background. Some include bios with fellowship and board certification information. But in this era of big data, such meager online offerings are hardly sufficient. Patients lament the fact that they can learn more about the quality of a door handle than about the quality of their physicians. Health systems that do not heed these complaints will find themselves losing patients and revenue.

Making performance transparency available publicly—in the form of a physician score, for instance—enables patients to choose the physicians who are most appropriate for them, increasing the likelihood of a positive outcome and a lower-cost recovery period.

In fact, patients are largely the ones demanding performance transparency, setting the stage for a shifting world in which high-quality performance transparency becomes the standard for health systems, which organizations can ignore only at their peril. Patients are demanding more information, better data, and a quantifiable assurance that the person they are relying on for treatment is the appropriate care provider for them.

This conversation currently is being dominated by websites best known for restaurant reviews and misguided journalistic endeavors that tell only a fraction of the story, and that lack the perspective of healthcare providers. It shouldn’t be this way, and it does a disservice to both patients and health systems to allow such subjectivity to dominate.

The healthcare industry amasses mind-boggling amounts of data every day. With the right analysis, rows and rows of data can be turned into actionable information that helps drive down costs and improve patient care. It is time for healthcare systems and hospitals to regain control of the performance transparency conversation, to replace the noise of opinion with irrefutable facts, and to give patients verifiable data that will help elevate the quality of care in this nation.

The healthcare industry has a unique opportunity to drive the flow of information and dictate its uses. With more data becoming available, performance transparency will either happen with health systems, or to them. It is their choice, but the time to decide is now.

For the health system finance executive, the transition from fee-for-service to value-based delivery is a significant change, especially from a financial risk point of view. Physician performance transparency is the key to enabling a fiscally responsible transition that enables new business models and offerings, while clearly understanding the business risk. Finance executives should play a leading role in helping their organizations take the first steps on the journey to performance transparency. This journey will enable their organizations to deliver higher-quality care at a lower cost, with clarity of risk.


David Norris is CEO, MD Insider, Santa Monica, Calif.

Footnotes

a. Accenture 2013 Consumer Survey on Patient Engagement.

b. The Digital Journey to Wellness, Google and Compete, Inc., 2012.

c. Contracting for Population Health Management, The Advisory Board Company, June 2, 2014.

d. Global Patient Safety Challenge: 2005-2006/World Alliance for Patient Safety, World Health Organization, 2005.

Publication Date: Monday, February 01, 2016

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