Mind the Data Gap: Improve Economics, Better Outcomes
Structural data gaps and information failures hurt patients, hamstring the coordination of care, and help fuel the ballooning cost of US healthcare.
In this post, we discuss the role of data augmentation and artificial intelligence (AI) in addressing information gaps and asymmetries to enhance visibility into patient journeys, with a focus on the impact on patient outcomes, provider satisfaction, and financial outcomes for provider systems.
Consequences of Information Gaps on Patient Care
Information gaps in the provider space occur when one party (e.g., provider, payer, or patient) has more or better information than another - typically manifest within healthcare markets via a lack of visibility into a patient journey, or all of the steps a patient takes as they seek and receive care. This can lead to inefficient clinical decision-making, with consequences such as delayed diagnoses, inappropriate care plans, and increased costs.
For example, a patient may receive an unnecessary (unwarranted or duplicative) test or treatment due to incomplete or inaccurate information, potentially leading to negative health outcomes and inflated financial burdens.
Complete Patient Journey Visibility for Improved Outcomes and Care Coordination
Gaining complete visibility into patient journeys is crucial for improving patient outcomes, care management, and coordination. With a comprehensive view of a patient's history (providers seen, diagnoses given, and procedures performed), healthcare providers can more effectively identify potential health risks, diagnose conditions, and prescribe appropriate treatment plans.
Improved visibility enables providers to better coordinate care, reducing duplicate tests and treatments, and ensuring patients receive timely, appropriate interventions. From a payor perspective (Employers, TPAs, and other first party payors), knowledge about the entire patient journey allows better risk management and insight into provider and population dynamics that may impact contracting, alignment and selection.
Data Augmentation and AI to Close Gaps and Enhance Patient Journeys
The wealth of information within health systems has transcended the patient-facing activities within them. Yet, daunting limitations persist due to lack of visibility into inter-system patient activity and non-owned physician behavior, deeply impacting the quality of healthcare output.
Filling these data gaps with focused external data resources helps minimize asymmetries and generates a more comprehensive perspective on the ecosystem surrounding patients and providers. Further leveraging advanced machine learning and reasoning techniques to understand network dynamics, relationships, behaviors, and patterns otherwise unattainable with the existing data resources. At the end of the day, leveraging holistic data and advanced analytical tools and techniques reduce information gaps and can help identify patterns and trends, support decision-making, and facilitate more personalized care.
Transform Care through Enhanced Visibility
Fiscal Stability. Enhanced visibility into patient journeys can reduce duplicate tests and treatments and improve care coordination, guide providers toward cost savings and optimize resource utilization.
Margins and Network Leakage. Comprehensive insights into provider behaviors helps to identify patterns of network leakage – instances where patients receive care outside of their established provider network – and implement strategies to retain patients and improve care continuity.
Increased Provider Satisfaction Increased visibility into patient journeys can lead to improved provider satisfaction via a comprehensive understanding of patient needs and enabling more efficient care coordination, healthcare professionals can experience greater confidence in their decision-making and reduced stress related to managing complex cases.
Conclusion
Addressing information gaps and enhancing visibility into patient journeys through data augmentation and AI technologies can have profound effects on patient outcomes, provider satisfaction, and financial outcomes for healthcare provider systems. By closing information asymmetries and leveraging advanced tools and techniques, healthcare professionals can more effectively manage patient care, coordinate resources, and ultimately, improve the overall health of their patient population.
If you enjoyed this blog or if you have questions/comments, please email rdeiotte@monocleinsights.com, or visit our contact page to continue the discussion on closing data gaps in US healthcare decision making.
