Historically, U.S. healthcare has been focused on treating illnesses rather than preventing them. As healthcare changes and value-based care is fully implemented, a proactive approach will be required to catch illnesses earlier and prevent costly medical procedures. If payers don’t have the ability to analyze meaningful data, they can’t accurately determine reimbursement levels or baseline treatment costs. The “one-size fits all” formula that has been standard for years will no longer be cost-effective. In order to capitalize on this change, the focus needs to shift to successful Population Health Management.
Fortunately, payers have all of the information needed at their fingertips. However, most lack the ability to analyze and supply the intelligence necessary. Payers who don’t use advanced data analytics to find meaningful relationships in data will encounter difficulties managing their patient population.
At Medical Search Technologies (MST), we can build you the database you need to transform and grow your business in the new healthcare environment. We start by pulling in all the data from past preauthorization courses of action into a single database for a specific code in order to adopt a unified model. We then employ our proprietary algorithm to find and classify data, and determine relationships between data points. This will begin to take the inconsistencies out of the preauthorization process so that both payer and provider can gain more predictability. Once complete, we retrieve the structured data and combine it with the newly structured data (derived from unstructured fields) to build a robust reporting, search and analysis portal. When Payers can effectively analyze their healthcare data, they will be able to rate and issue policies, evaluate provider and treatment effectiveness, and develop innovative products.
Applications to consider: Sophisticated Searches, Transform Your EMR