Next-gen healthcare finance tools: AI and blockchain will help hospitals adapt to value-based care
Healthcare is in the midst of a financial shift: value-based care is rising to the fore and hospitals simply have to share more of the financial risk. That means financial information systems must adapt to the new environment.
Experts in financial IT have a wide variety of ideas on where the next generation of features and functions will manifest.
There are three major features healthcare CIOs need to pay attention to in their planning for next-generation financial management tools: visualization, artificial intelligence and blockchain, all delivered via cloud services, said John Moore, founder and managing partner at health IT consultancy Chilmark Research.
AI, blockchain and visualization
“Visualization may be argued as not exactly next generation in many sectors of the economy but the slow pace of IT adoption in healthcare puts this on the list,” Moore said. “With richer, easier to use visualization tools, end users will be able to self-query data on the fly leading to less of a reliance on basic reporting functions that many IT shops must contend with today.”
Artificial intelligence also will become an increasing presence in financial management systems, Moore predicted.
"In healthcare, the combination of blockchain and smart contracts can greatly facilitate claims adjudication and processing."
John Moore, Chilmark Research
“Rarely will AI be delivered on-premise but instead AI solutions will typically be delivered via a cloud-based service,” he explained. “Expect young start-ups to leverage open source AI tools such as Google’s Tensor Flow while more established companies such as Oracle and SAP acquire such capabilities and fold in with their existing solution suite.”
And blockchain has the potential to dramatically change how financial technologies are delivered – enormous amounts of funding by some of the largest global financial institutions will lead to a more robust platform for conducting business, Moore said.
“In healthcare, the combination of blockchain and smart contracts can greatly facilitate claims adjudication and processing, thereby removing significant friction in today’s transactional processes across the healthcare sector, processes that contribute to more than 20 percent of total healthcare spend,” he said.
Value-based care and risk adjustment
Brian Croegaert, senior vice president of value-based care services at Arcadia Healthcare Solutions, an EHR data aggregation and analytics tech firm that supports value-based performance management for providers and payers, also identifies three areas where financial IT will have to change in healthcare in the years to come.
In the next two to five years, healthcare will move to a world in which everything is based on managing some level of risk – and financial management technology needs to move toward that focus in care, Croegaert said.
“First, risk adjustment tools to help the organization understand and increase its risk profile appropriately,” he added. “The health system should be able to accurately understand and document the risk of its population, and use clinical insights to identify and resolve instances where patient risk is inaccurately documented.”
If risk is under-documented, the health system will not receive sufficient payment; if risk is incorrectly overstated, the health system will risk audits and fines. Next-generation financial systems will need to automate identification of potential risk documentation gaps to avoid costly chart audits, and should present potential documentation gaps at the point of care for review and closure by clinicians, Croegaert said.
Second, performance analytics will be needed to help earn outcome-based bonus payments, Croegaert predicted.
“A next-generation financial system should allow a healthcare organization to see how far it is from earning performance-based bonus payments – and importantly, should facilitate collaboration between the finance and quality improvement teams by helping identify the specific, actionable clinical initiatives that would have the most impact on bonus performance,” he explained.
"Ideally, the next generation system will synthesize best practices about how to manage risk and transfer that knowledge to physicians via easily consumable tools that support decision making at the point of care."
Brian Croegaert, Arcadia Healthcare Solutions
When an organization is working with limited resources, deploying them strategically to a small, targeted set of providers for care gap closure can have an outsize impact on earnings, driving additional dollars that can then support more clinical resources, he added.
And third, resource allocation and utilization reporting that makes sense at the point of care will be a must, Croegaert said. Health systems will need a good sense of how they are spending money as they take on increasing risk.
“In a fee-for-service environment, this does not matter – the only real risk is whether the patient covers his or her out-of-pocket expenses,” he said. “But in the future, health systems will need to know what is being paid for care, and whether the care being provided is timely, clinically appropriate and priced appropriately. A next-generation financial system should give physicians a multivariate way to drill down into understanding how they are expending their resources.”
Insurers have long had financial management systems that do this, but for the most part, these tools have not been available to health systems. As finance leaders begin to expect physicians to think about resource allocation and utilization, the ease of use of the systems they provide will be critical, Croegaert said.
“Ideally, the next generation system will synthesize best practices about how to manage risk and transfer that knowledge to physicians via easily consumable tools that support decision making at the point of care,” he explained.
There shouldn’t be any surprise that healthcare is shifting into value-based models, and if provider organizations want to remain profitable and sustainable, they must deliver on patient outcomes. So, as a starting place, successful healthcare CIOs must align their goals with the requirements of payment models and the direction of the industry.
“That said, provider organizations generally will have a goal of achieving the Triple Aim – providing better care at lower cost while improving the patient experience,” said Mike Hoxter, chief technology officer at Lightbeam Health Solutions, a vendor of clinical and financial analytics technology.
"Provider organizations need to consider all day-to-day operational and clinical workflow parameters in order to truly effect meaningful change within an organization."
Mike Hoxter, Lightbeam Health Solutions
When it comes to next-generation features and functions of financial IT, it will have to include a fully integrated, end-to-end population health management suite, he said. Population health management and data analytics have been big buzzwords over the last few years, but adding ‘end-to-end’ opens up a world of new options for CIOs, he said.
“When looking for a population health and data analytics solution for financial management, provider organizations need to consider all day-to-day operational and clinical workflow parameters in order to truly effect meaningful change within an organization,” Hoxter explained. “This can only be accomplished by combining holistic aggregation of clinical and financial data from disparate sources via an enterprise data warehouse, plus risk stratification criteria of the patient population both by spend and by overall health.”
In addition, health systems must leverage financial and clinically driven analytics combined with care management protocols that allow for immediate provider and patient engagement.
“CIOs should be looking for financial management technology that delivers a data analytics platform that takes into account all facets of clinical and claims data from disparate sources,” he added. “In addition, the technology should include a robust suite of population health functions, including the delivery of comprehensive risk stratification and normalization across the enterprise, the identification of gaps in care, the management of key performance indicators, the presentation of predictive modeling and analytics, and the integration of actionable data with care coordination, provider and patient engagement tools.”
An enterprise data warehouse alone is not enough to achieve the outcomes provider organizations need to succeed in value-based reimbursement, but it is the first and foundational step of an end-to-end health IT technology platform for financial management.
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