Let’s be honest. Deep-dive data discussions may not top your list of compelling topics unless the subject has personal significance or you’re looking for ways to improve provider performance and patient outcomes.
Or perhaps you’re working on behalf of self-insured employers, brokers, third-party administrators (TPAs), consultants, hospitals, health systems, healthcare providers, and advisors to identify proven ways to lower benefits spend and improve the quality of care for employees.
Regardless, understanding the significance of Healthcare Bluebook’s (Bluebook) acquisition of the provider quality division of Quantros Inc. (Quantros) is a game-changer in a market that’s quickly moving toward a value-based care system that rewards providers who deliver the highest quality care at the lowest possible price.
As hospitals continue their rapid migration from inpatient to outpatient care, the only way to accurately evaluate the full care continuum is to view a comprehensive and detailed roadmap of the patient journey driven by both inpatient and outpatient data. Now, that’s possible.
A view like no other
Prior to joining Bluebook, Quantros supplied Bluebook’s healthcare outcomes data for more than eight years, developing the framework for the symbiotic relationship between two industry pioneers.
Combining Bluebook’s quality-cost data and navigation tools with Quantros’ deep expertise in provider quality data shifted the healthcare transparency landscape by creating opportunities for unparalleled analytics capabilities to benefit Bluebook–Quantros clients.
Understanding the full scope of the patient journey, from both financial and quality of care perspectives, enables clients to pinpoint cost waste and quality deficits, identify savings opportunities, and improve outcomes by navigating patients away from poor-performing providers and guiding them to high-value care.
A revolutionary shift in outcomes analytics
For nearly three decades, Quantros has helped clients analyze and improve their performance through a vast dataset of inpatient claims, which grew exponentially with the latest Bluebook-Quantros innovation, Outcomes Analytics+ (OA+), a groundbreaking approach to healthcare analytics.
With input and insight from industry leaders across the country, OA+ combines both outpatient and inpatient data to provide an unprecedented line of sight into the performance of hospitals, systems, and physicians across the continuum of care.
Primarily, provider quality analytics have been focused on a single event (encounter-based), offering a narrow picture of the inpatient-only experience.
But according to Bluebook’s Chief Product Officer, Lindsey Klein, in the last 10 years, the bulk of Quantros’ clients saw their outpatient volumes, including emergency and observation patients, outpace their inpatient volumes, prompting a re-evaluation of Quantros’ outcomes methodology.
“To support our clients in the way they need, we knew we had to move away from an inpatient-only analysis and provide a comprehensive solution that looks across the continuum to create a broad view of the patient care cycle,” explained Klein.
A new perspective on meaningful data
OA+ uses episodic analytics to evaluate groupings of more than one related encounter to allow performance comparisons, track patient progress, and compare and contrast patient outcomes and efficiency across multiple facilities and care settings.
“Many patients are chronic patients that are being managed both medically and surgically in different settings with different interventions over a period of time, often moving between inpatient and outpatient environments,” said Klein. “We evolved our solution to look at patient movement and identify bottlenecks in assessing performance and costs across those continuums.”
But simply adding more datasets and groupings isn’t enough to get a full and accurate picture of episodic data to optimize value-based strategies. To be fully successful in a value-based environment, providers must share responsibility and accountability to boost transparency and enable better care coordination.
OA+ feeds all client provider data across multiple facilities and care settings into an intuitive and interactive dashboard to create an aggregate snapshot, or scorecard, of a hospital’s performance with industry-best metrics that include:
- Mortality rates
- Unplanned encounters
- Patient Safety Indicators (PSIs)
- Hospital Acquired Conditions (HACs)
Yet even where similar procedures and chronic conditions occur, patients are diverse with varying risks. To predict how likely a patient is to experience an adverse event, OA+ risk-adjusts scores to account for age, gender, and comorbidities where more than one risk factor can affect a patient’s clinical outcomes.
Klein clarified, “If I have diabetes and I’m being treated for a heart issue, that’s going to have a bigger impact than if I have diabetes and I’m being treated for cataract surgery.”
Performance scores are combined to form an Overall Quality Score with at-a-glance views of facility and physician performance—critical insight as CMS rapidly moves toward a value-based reimbursement model in an arena where there is no correlation between quality and cost: Lower cost doesn’t necessarily mean better value.
The Bluebook-Quantros methodology asses both cost and quality metrics to identify the intersection where the highest value is achieved.
Additionally, OA+ drills down to a pinpoint view of poor-performance drivers to identify adverse patterns within certain diagnosis areas, procedures, treatments, or physicians to deliver on-demand analyses, including:
- Actionable Visual Data to help develop scalable quality improvements and strategies to reduce variations in cost and care
- Visibility across the facility’s entire patient population
- Comparative Analysis of performance and benchmarking at the hospital, physician, episode, diagnosis, service line, and procedure levels
- Critical Insight into competitor performance and market analytics
The culmination of decades of studying patient populations, the value of OA+ extends far beyond a scoring system. Quantros learned long ago that every nuance of the healthcare continuum plays a role in the patient journey, just as Bluebook discovered the symbiosis between healthcare quality and cost, the guiding light to high-quality care at a Fair Price™.
Throughout the ever-evolving healthcare landscape, Bluebook and Quantros shared a common value before the two companies ever crossed paths: The patient is the center of the healthcare continuum.
Joining the expertise of two market leaders in healthcare navigation and provider quality outcomes creates enormous opportunities for providers to improve the quality of their care and streamline efficiencies that raise their value benchmarks; and fortifies organizations with precise and truthful information to better care for their employees through enhanced benefits programs … powerful harbingers for change in an industry that has never needed it more.
Today is the day
Healthcare Bluebook serves more than 8,000 clients, 2M enrolled employees, and nearly 5M lives. The outpatient data in OA+ adds more than 500,000 new physicians and 175 million additional patient encounters each year to the Bluebook-Quantros dataset.
Why wait when you can begin today to lower benefits spend, improve provider performance, and turn the tide to create a more successful patient experience?
Contact us today for more information on our services for providers or to schedule a demo of OA+.
For additional resources and more information on Healthcare Bluebook’s full suite of services, visit www.healthcarebluebook.com.