Leveraging Data to Reduce Risk: 3 Predictions for Healthcare in 2021

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By Emad Rizk, M.D.

As the COVID-19 pandemic continues, the wave of infections this fall is proving to be larger than the previous waves. The healthcare industry has quickly been working to leverage data to improve detection, surveillance and health outcomes—and data scientists have risen to the occasion. 

Today, healthcare organizations have gained the ability to predict infection hotspots days before they occur, pinpoint social determinants of health that increase COVID-19 mortality rates and help close gaps in care for vulnerable populations. Management of the disease has also improved significantly as fatality rates decline. Now, as the industry looks to 2021, the advancements in data analytics made during COVID-19 will strengthen not just the nation’s clinical response, but also its approach to managing risk.

Here are three predictions on how data analytics will reshape healthcare’s response to COVID-19 in the year ahead.

Tightly integrating supply chain intelligence with public health. The rollout of a COVID-19 vaccine is likely to accelerate in 2021, with two or more pharmaceutical companies now moving rapidly toward the finish line. This will require a level of supply chain collaboration and logistics not previously seen in healthcare. According to a recent Wall Street Journal article, warehousing and distribution contracts have been signed to accommodate distribution of a COVID-19 vaccine and “freezer farms” are being built near major airline hubs to safely store a vaccine—and these are only some of the transportation logistics involved. Data also will be critical to determining which populations receive the vaccine first and keeping track of who received the vaccine so a second dose can subsequently be delivered. Additionally, documenting the side effects and breaking down these reactions by demographics such as age, race and comorbidity will be crucial to assessing the risks of the vaccine for specific groups.

In 2021, expect to see significant data exchange between the public and private sectors—including pharmaceutical companies, transportation and logistics providers, government agencies and healthcare organizations—as a COVID-19 vaccine is distributed on a wide scale.

Designing intelligent payment rules that take risk into account. There is already speculation that COVID-19 will accelerate value-based care. In a recent op-ed, the Centers for Medicare & Medicaid Services suggested that providers need more skin in the game—with downside risk built in—for value-based payment programs to truly work. They also need timely access to data to intervene earlier to reduce health risk among vulnerable populations. 

In 2021, as pressures to contain healthcare costs intensify, expect to see increased focus among health plans to reward providers for risk stratification: providing the right care to the right members at the right time. This will require collaboration between payers and providers that is grounded in data. For example, recent analyses of clinical and claims data point to underlying conditions that put patients at higher risk for health complications during COVID-19, and this list is continually growing. By sharing timely intelligence such as this with providers, physicians and clinicians become empowered to take decisive action that improves quality of care and outcomes. For example, healthcare professionals are learning that the use of corticosteroids, various monoclonal antibodies, and other treatments are highly valuable as new therapies. 

Accelerating efforts to reduce waste and abuse across settings. The rate of telehealth use exploded during the pandemic, with $29 billion in healthcare services expected to be delivered virtually in 2020 alone, comprising 20% of visits. Much of the rise in telehealth is due to relaxed regulations by the federal government, including equal reimbursement for telehealth and in-office visits as well as audio-only telephone visits. But loosened restrictions also have accelerated incidents of fraud, waste and abuse in these new settings of care. Already, $4.5 billion in fraudulent telehealth claims have been detected this year, according to the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services.

In 2021, expect payers to step up efforts to crack down on fraud, waste and abuse using data to inform their response. Leading payers are collecting data around utilization, financial profiles of providers and documented high-impact schemes, such as those recently uncovered by the OIG, to spot instances of potential abuse before claims are paid. Payers will also increasingly use logic-based rules for specific types of claims, such as claims that reflect unusual patterns in utilization.

A Data-Intelligent Approach to Care Challenges

Throughout 2020, data scientists became increasingly skilled in using data to predict the spread of COVID-19, forecast the double impact of the flu and the coronavirus on hospitalization rates and more. In 2021, tighter integration of data across the public and private sectors will empower healthcare organizations to develop a more sophisticated response to curtailing the spread of infection and preventing fraud, waste and abuse. This approach will lead to more effective management of risk, better health outcomes and increased value in 2021 and beyond.

Emad Rizk, M.D., is President and CEO of Cotiviti and brings a 30-year, well-documented track record of delivering improved quality and financial performance to healthcare organizations through forward-thinking leadership, business acumen, and clinical expertise.

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