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The development of value-based reimbursement methods as the U.S. CMS continues to study a variety of value-based payment models like pay for performance (P4P), episodic and bundled payments, and will develop additional regulations to meet its future goals that demand a greater share of provider payments using these models; Payers and providers need to understand the complete risk environment related to the under-writing and management of these new reimbursement models, and this is a key area for analytical tool support.


Following are some of the key drivers of analytics in the healthcare market:


Shift in responsibilities for financials and health management to individuals gives more power to individuals and hence improving member experience using analytics is a necessity.


Low CEM scores relative to other industries due to lack of adoption of analytics.


Chronic diseases contributing to 65% of healthcare expenditure due to lack of care management practices.


5% of the population utilizes over 50% of healthcare spend and hence identifying that group and improving the quality of care will certainly bring down the costs


Shift in responsibilities for financials and health management to individuals gives more power to individuals and hence improving member experience using analytics is a necessity.


Low CEM scores relative to other industries due to lack of adoption of analytics.


Vol. 5 Issue 4 Aug 2016


HOSPITAL & HEALTHCARE MANAGEMENT www.hhmglobal.com


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