Module 7 Analytics and Vendor Management - Health Flashcards
What does data analytics mean in the health care context?
the process of inspecting, cleaning, tranforming, interpreting, and modeling data to discover trend, patterns, and other information that can support benefit plan decisions and changes in order to reduce costs and improve clinical outcomes
What is predictive modeling in the health care context?
used to forecast future behavior by analying historical and current data to generate a model to forecast future outcomes to quantify risk and costs for individuals and groups of individuals in the health plan
What are the ways predictive modeling can be leveraged by health plans?
a) review a plan’s disease burden and how it will change over time
b) stratify a plan’s population by risk level to identify at risk and catastrophic claimants for targeting diesease management and case management
c) identify risk factors likely to generate future plan costs that should be targeted with more intensive outreach
d) compare relative resource consumption by groups for budgeting and underwriting forecasts
e) compare providers fairly by adjusting for differences
f) analyze a medical management program to see what the true savings are
How can health plan sponsors use data analytics and predictive modeling?
a) identify claims trends
b) target high risk users
c) identify gaps in care
d) steer patients to the best providers
e) measure vendor performance
f) uncover cost sharing strategies
g) engage participants in their own care
h) investigate waste, abuse, and fraud
What are the 5 recommended steps that plan sponsors should take to implement data analytics and predictive modeling tools?
a) determine who will perform the data analytics
b) use data analytics and predictive modeling to identify and map the most prevalent clinical risk characteristics and associated costs
c) establish a three-year health management strategy
d) develop a formal participant communications strategy
e) identify how plan participants will react to change
What are the three key areas of concern regarding the collection of health data in wellness programs?
1) informed consent to collect the data
2) data handling
3) employment discrimination
To what extent to which the confidentiality protections afforded by HIPAA apply to data collection associated with wellness programs?
employees must be made aware of not just health effects of a wellness plan but also the privacy risks
To what extent are employees currently informed to the scientific evidence underpinning the health imperatives suggested by a wellness program?
wellness programs are not subject to regulation by any government or licensing body
What is the quality of informaiton provided by wellness programs on wearable electronic devices?
research on the functioning of wearable electronics indicates irregularities in the data being collected and that wearable devices are unreliable
What limits exist on the amount of health informaiton that can be collected by a wellness program?
recent cases have indicated that the type of data a wellness program is enabled to collect can seem boundless
Who owns and controls the data collected in a wellness program?
may legally be the property of the employer, joining a wellness program is an act of trust
What are the core promises that have been suggested for an ethical workplace wellness program to adopt?
1) commit to accountability in data collection and use
2) guarantee no penalty for nonparticipation
3) adopt gold standar practices for data security
4) provide awareness of discriminatory potential of data
5) allow for portability of data by employees
6) minimize data lifespan to the period of employee participation
7) disclose to employees that collected health information may not fall under HIPAA
8) guarantee that all health recommendations are backed by peer reviewd researcht that is provided to the employee
9) provide clear informaiton about the irregularities and unreliabilitiy of data from wearable electronic devices
10) inform employee about the potential of the data to be used as evidence in court
What are general criteria/questions that a health care plan sponsor should discuss with or ask a potential data analytics vendor?
a) completeness of vision
b) culture and values of senior leadership
c) ability to execute
d) technology adaptability and supportability
e) total cost of ownership
f) company viability
What are the key considerations for success when a health care organization is implementing an analytics initiative?
a) data modelinga nd analytic logic
b) master reference/master data management
c) metadata repository
d) managing white space data
e) visiualization layer
f) security
g) extract, transform, and load (ETL)
h) performance and utilization metrics
i) hardware and software infrastructure
j) cultural change management
What are the 8 levels of analytics adoption that an organization passes through as it gains sophistication in using its data to drive improvement?
1) Enterprise data warehouse
2) Standardized Vocabulary and Patient Registeries
3) Automated Internal Reporting
4) Automated External Reporting
5) Waste and Care Variability Reduction
6) Population Health Management and Suggestive Analytics
7) Clinical Risk Intervention and Predictive Analytics
8) Personalized Medicine and Prescriptive Analytics
