Hospitals and healthcare organizations have no shortage of obstacles moving into 2023. Despite this dire proclamation, the healthcare industry has the opportunity to transform itself as long as it sets the right goals and supports them with analytics. Let’s look at some critical goals healthcare organizations can leverage data to support in order to build a strong, innovative foundation for the coming years.
Start Using Analytics Now to Prepare for Redetermination
When the COVID-19 pandemic began, Congress enacted the Families First Coronavirus Response Act (FFCRA) in response to the swelling healthcare needs of the general public. It prohibited states from disenrolling individuals from Medicaid while the public health emergency (PHE) was in effect, a condition of a temporary increase in the federal Medicaid match rate. As a result, total Medicaid and CHIP enrollment grew to 90.9 million by September 2022, almost a 20% increase from February 2020.
However, Congress is currently set to end the continuous enrollment provision this year and phase down the match rate. This unwinding process will likely see around 18 million people drop off Medicaid due to redetermination of qualifying status, with nearly 4 million of those becoming uninsured. Although the effects of unwinding will depend a lot on each particular state, hospitals and healthcare organizations must begin to prepare for the confusion.
Much of those preparations will involve an investigation into the local impacts of the redetermination. Important data would include:
- What percentage of the local community would likely lose Medicaid coverage, even temporarily
- How redetermination might impact volumes
In addition, predictive inquiries could be:
- Whether there is a high chance that instances of bad debt will rise thanks to disruptions in care
- What training intake counselors might need to handle customer dissatisfaction or confusion.
The end of PHE will cause some upheaval. Still, healthcare organizations can leverage data tools to understand the current state of healthcare in their area as well as make better predictions about what to expect based on that data.
Engage Robust Decisioning Tools
We almost titled this section “embrace agile,” but it’s more than that. Nearly every industry is embracing some level of agile operation because if the pandemic taught us anything, it’s that change happens. The most resilient organizations are those able to pivot quickly while making great decisions and continuing to serve their customer bases — or in the case of healthcare, patient bases.
The key foundation to this particular resolution is ensuring that data-driven decision-making is the norm. Many healthcare organizations are in the process of flattening management structures to improve hospital efficiency. Others are making tough decisions for what programs and services to keep and which to cut in order to reduce costs. Both of these infrastructure-related decisions — one organizational and one finance-focused — will require reliance on top-quality, real-time data to ensure a good decision.
Ideally, healthcare organizations will be able to harness all data from multiple systems, including legacy ones. This data can help make key decisions easier. For example, hospitals pushing into care that happens before or after a hospital stay — think ambulatory care or hospital-at-home programs — can determine the type of care that will best serve area patients while minimizing financial risks to the organization. In addition, a hospital might determine when it’s most beneficial to bring in a physician as a full-time medical staff member instead of relying on partnerships with private physicians.
Whatever the decision is, grounding it in real-time data will allow hospitals to improve decision-making. They’ll be able to shift services more quickly to meet demand while optimizing existing infrastructure and resources.
Target Ambitious but Efficient Growth
Healthcare organizations must do more than cut costs to succeed. There must also be strategic initiatives to grow and expand services and acquire new patients. Organizations might be tempted to focus only on restrictions in response to continued disruption, but this won’t serve their best interests in the long run.
A recent McKinsey survey noted that a majority of respondents planned to focus on diversification over the next three years. This comes in response to industry trends that are seeing an increase in different types of care outside the traditional hospital setting, including ambulatory care and hospital-at-home programs as mentioned above. Currently, according to the McKinsey study, rising costs and a reliance on investment income in the nonprofit healthcare sector leave many organizations vulnerable to economic factors.
As a response, diversification of services could help prevent major upheaval each time a disruption occurs. Bringing primary care doctors into full hospital employment, an example mentioned in the previous section, is one way these organizations are adding key service components that bring value to patients while generating new revenue.
Growth requires a clear look at the data, but silos in healthcare data can prevent organizations from finding new opportunities and understanding what services will bring the greatest return. Building a unified data ecosystem can help facilitate coordinated, strategic growth.
Building the Right Healthcare Goals in 2023 Requires a Commitment to Digital Transformation
Healthcare organizations and the industry itself understand the way that disruption can derail services and change the way hospitals operate nearly overnight. Surviving and thriving in the modern healthcare landscape means adopting a more agile, flexible approach to delivering services and making decisions —balancing the need to be efficient with the necessity of innovation. And with major changes like redetermination on the horizon, getting that balance right is more important than ever.
Building data-driven decision-making into the equation can help healthcare organizations understand and forecast the impacts of changes like redetermination, balance efficient growth with cost efficiency, and better understand the patient community they serve.
Learn more about how healthcare organizations can more easily reap the benefits of becoming a data-first organization in our white paper, Data Mesh + Patient360: A Modern Revolution for Healthcare Data.
