Wednesday, December 26, 2012

Piedmont & WellStar Broaden the Data Ecosystem

Piedmont and WellStar are creating their own insurance company.  Hopefully, this trend will take off and we'll see a significant disintermediation of third party insurance, like Blue Cross and United, and insurance company profits can thus instead be channeled back into the healthcare delivery organization and a portion of those profits can be redirected as dividends and returned to patients-- the stockholders in healthcare.   Here's the article in The Atlanta Journal-Constitution.

Piedmont and WellStar's decision is a great step towards a common sense ACO, without the crazy overhead and complexity of a federal ACO. If you look closely, the most respected and revered healthcare delivery organizations in the US include their own insurance company under a single, overarching CEO who balances care delivery with economic affordability and risk management towards quality of care, not volume of care. Those CEOs, like Charles Sorensen of Intermountain Healthcare, are "accountable" for balancing healthcare quality in hospitals and clinics with healthcare economics in the insurance company.

Note, at the heart of this business strategy is DATA. In order to fully manage a patient's healthcare in an accountable manner, healthcare delivery organizations must expand the data ecosystem that are available to them for analysis. Claims data is one piece of that ecosystem, along with inpatient clinica data, outpatient clinical data and eventually, patient reported data, particularly outcomes and quality of life data, which is largely missing in today's healthcare analytics environment.

Compliments to the leadership teams of Piedmont and WellStar. Let's hope other healthcare executives that fancy themselves as leaders, will follow. :-)

No comments:

Nuclear and Healthcare Decision Making

Nuclear warfare operations was my data-driven decision making environment before the healthcare phase of my career. It was all about recogni...