Integrating Data Sources to Create a New Innovative Learning Environment for Healthcare Systems

This summarised version of a white paper, co-authored by Robert McGough, partner at Hill Dickinson, and Mark Ratnarajah and Steve Barnett from C2-Ai, explores the urgent need for a transformative, data-driven, value-based approach in healthcare systems, particularly in the post-pandemic context.

As health services worldwide struggle to adapt to the post-pandemic scene, the pressing need for a transformative approach in the healthcare sector, against a background of increasing demand and finite resources, has never been greater. This report, co-authored by Hill Dickinson and C2-Ai, advocates for a coordinated, data-driven, value-based strategy in healthcare planning and provision. Such a strategy aims to enhance patient outcomes and cost efficiency by emphasising transparent data collection, analysis, and application. The goal is to design and implement systems that consistently improve patient outcomes and service quality within a safe, transparent learning environment.

Traditional Healthcare Reforms

Traditional healthcare reforms have predominantly focused on narrow goals, such as improving access, restructuring organisations, and controlling costs. However, these approaches often fall short of addressing the fundamental challenges of sustaining and enhancing health services. This report proposes a more comprehensive value-based approach, leveraging extensive data sets and insights-driven analyses, as a transformative solution. This approach seeks to deliver optimal outcomes at the most efficient cost, fostering a learning-based environment for clinical practice and collaboration across the whole arc of care.

Quality and Learning

Current incentive systems designed to enhance healthcare quality are inadequate. Existing contracting and payment models frequently reward volume over outcomes, leading to inefficiencies and adverse impacts. For instance, prioritising reductions in emergency department waiting times can cause delays in elective admissions due to a lack of bed availability. A shift towards outcome-based targets would align financial rewards with patient health improvements, encouraging innovation and flexibility in treatment approaches.

An Alternative Approach to Data, Finance, and Contracting

The proposed strategy involves transitioning from a supply-driven to a patient-centred system. This entails evaluating the value generated from achieving high-quality patient outcomes and the costs associated with a full cycle of patient care. Current models that remunerate based on patient volume discourage directing patients to community or primary care, potentially impacting hospital funding. A new value-based, data-driven approach necessitates rethinking how healthcare delivery is organised, contracted, measured, and reimbursed.

The Power of Data                                                   

Data is crucial for planning and delivering improved care, yet it is often inaccessible or siloed, limiting its potential. Once shared, data analysis can drive significant improvements in clinical performance and patient outcomes. Integrating data into contractual and finance models can incentivise enhancements and promote collaboration. A comprehensive data strategy includes clinical, financial, procurement, and claims data, providing a holistic view of healthcare performance. The importance of risk-adjusting clinical outcomes^1,2 to recognise the case mix complexity of populations cared for is relevant to the analysis, such that higher acuity care is fairly represented in terms of direct costs, resources and reflects expected clinical outcomes compared to observed.

Wider Datasets

The report emphasises the importance of broader datasets – encompassing clinical data, financial data, procurement data, and claims data. These datasets provide insights into areas needing improvement and help target interventions. For instance, clinical data can identify complications and readmission rates, while financial data tracks costs across care pathways. Procurement data highlights inefficiencies in medical device usage, and claims data reveals areas prone to legal disputes.

Creating a Learning Environment

By integrating data from diverse sources, healthcare systems can establish a transparent learning environment focused on incentivising behaviours that enhance clinical and operational outcomes. This environment supports identifying improvement areas, tracking provider performance, and facilitating system changes for better patient outcomes and the delivery of more equitable care across increasingly diverse communities. Addressing legal and regulatory barriers to data sharing is crucial for this transformation.

Supporting Structures

Contracts play a pivotal role in enabling healthcare organisations to utilise data effectively. Key components include longer contract durations, risk and gain-sharing mechanisms, and collaborative contracting models. These elements foster a partnership-based relationship centred on patient outcomes rather than financial confrontations.

A New Financial Model

Transitioning from fee-for-service and block-based approaches to a value-based financial model is essential. This change fosters a collaborative dynamic between providers and payers, incentivises best practice dissemination, identifies waste and integrates care across multiple parties. Focusing on patient outcomes and health equity ensures high-value innovation and overall system performance improvements.

Achieving the Aim – a Focus on Patient Outcomes

The proposed model emphasises true patient outcome measures over input and process metrics. Clear, measurable performance standards aligned with patient outcomes and robust data support this approach. The new contract model promotes collaboration, aligns incentives and supports a transition process to mitigate organisational risks.

Conclusions

Healthcare systems have both a critical need and an opportunity to reimagine data usage and coordination. A focus on patient outcomes, supported by transparent data and a learning environment, can significantly improve healthcare quality and efficiency. Well-designed contracts and financial models are essential to achieving these goals.

To download the full report, please click here.

This is just one of the articles that appears in the ‘Health, Care and Life Sciences’ section of Chamber’s pre-election journal. To subscribe to receive access please click here.