This article is sponsored by SimiTree. In this Voices interview, Behavioral Health Business sits down with Melanie Elliott, PhD, Vice President, Analytics Strategy, Afia Analytics, a SimiTree company, to talk about why behavioral healthcare analytics needs to do more for providers than report data per standard measure definitions. She discusses the need to put actionable insights into the hands of all staff in order to reduce cost & improve client outcomes. She also outlines the steps providers can take to improve the efficiency of data reporting and make the insights more meaningful.
Behavioral Health Business: What career experiences do you most draw from, in your role today?
Melanie Elliott: Healthcare involves many complex systems and factors. My research as an Assistant Professor involved understanding those complex factors that influence human behavior and wellness as well as developing novel ways to measure them. Outside of academia, I coordinated analytics for two behavioral health EHR companies These experiences really helped me grasp the difficulty providers face to not only deliver care and improve client outcomes but also to collect and synthesize data meaningfully for various stakeholders.
How can you improve data access and data sharing through aggregate data warehouses across providers, such as at the regional or state level, for purposes of condition management and care coordination?
To better serve the behavioral health population, we must understand them beyond demographics, looking at health disparities and other factors while addressing data gaps and health care service engagement. Effective care coordination is key because not all services can be centralized. Collaboration between primary care, behavioral health and specialty providers allows our clients to provide comprehensive care, focusing on individuals’ immediate needs and long-term health.
Accessing and sharing data is also critical to evaluate the impact care or a lapse in care quality. Now, obtaining data from various sources may not always be straightforward, but we are adaptable to various workflows and data formats. Our approach allows providers to retain their preferred systems, promoting flexibility and respecting privacy regulations. We maintain the power of client- and service-level analytics while keeping Protected Health Information (PHI) secure and honoring Releases of Information (ROIs).
Data sharing extends beyond basic information, encompassing diagnoses, hospital stays, vitals, social determinants of health and care continuum history to enhance performance evaluation and collaboration within the health care community. A collaborative network helps providers move from competition to cooperation, which, through data sharing, enables more effective negotiations with payers and improved client outcomes.
How can you reduce the time and effort required for providers to report data to payers and other entities, and make the data that they’re collecting work for them by providing meaningful insights that they can use in clinical decision-making?
In the healthcare industry, we have always aimed for the Holy Grail: having everything a provider needs right at their fingertips during patient care. However, it is difficult for vendors to cater to every provider’s needs across data sources, making it challenging for providers to access all the necessary data in a single place at the point of care.
With our Afia Navigator product, we take a different approach. We gather data from various sources, regardless of the software system or location. This includes EHR data, general ledger information, human resource systems, HIEs, assessment portals, and more, consolidating it all into one accessible platform.
This approach benefits clinical decision-making because the entire staff can track and evaluate the care journey, identify regressions and improvements, and assess the impact and cost of therapeutic interventions and services. This level of visibility enhances client and staff engagement, providing a sense that they’ve made a real difference.
What are some of the key challenges of implementing data technology and how can providers overcome them?
Data technology is abundant today, but implementing solutions that meet diverse provider needs is still challenging. Providers must address payer requirements, care standards, and cope with other varying reporting requirements, even within the same state. To assist providers, we advocate for collaboration among state and federal payers and stakeholders to establish standard metrics. This simplifies workflows and improves data quality by aligning everyone toward common outcomes. We aim to eliminate “homegrown metrics” that have unique definitions and reporting requirements that cause confusion. Thankfully, standard metrics like HEDIS, UDS, and CCBHC provide structured frameworks.
Providers struggle to capture data due to diverse workflows across different service lines and patient groups within their EHRs. Ensuring that source data systems, like EHRs, are implemented optimally can reduce duplication and inefficiency. Finding a trusted advisor who can consult on this and understands analytics and technology can play a pivotal role in this effort.
How can you monitor provider costs to ensure good margins for growth and sustainability as well as illustrate cost-effective client improvement?
In health care cost discussions, the spotlight is often on population health expenses and per member per month (PMPM) costs. Roughly 5% of the population, encompassing both physical and behavioral health needs, accounts for nearly 50% of health care spending. This underscores the need to improve their physical and behavioral health care while reducing costs.
Maintaining healthy margins is vital for provider growth and system stability. However, many cost calculations rely on claims data, which is delayed, retrospective, and focused on billable services only. To gain a more accurate cost understanding, we consolidate the EHR data, General Ledger income statements and payroll records to determine the actual expenses incurred by providers. This information allows us to answer critical questions and evaluate the effect on the organization by considering volume and actual cost. Providers can also assess staffing needs for expansion by understanding costs relative to reimbursement. Understanding true costs, including non-billable services, is essential for demonstrating cost-effectiveness.
What is your outlook on data technology in the behavioral health space?
I think it is exciting and promising. We’re experiencing a remarkable level of alignment on what needs to be accomplished: sharing data, taking ownership of data, establishing standard measures and actively benchmarking them. Although it may take time for everyone to converge on the same path, there’s a clear shift in mindset, and we’re collectively prioritizing data access, data sharing and client wellness. All of this is done with a conscious awareness of cost considerations.
Finish this sentence: “In the behavioral health industry, 2023 has been defined by…”
… efforts to move towards value-based care. We haven’t reached that point yet, but I believe that providers, payers and technology vendors are embracing value-based care. We’re not solely exploring alternate payment models, but rather a genuine commitment to value-based care, where the primary focus is on improving client outcomes. Our goal is to determine the time, the specific services required and the associated costs necessary to transition a client from an unhealthy condition to a healthy one, and more importantly, maintain their well-being.
Editor’s note: This interview has been edited for length and clarity.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].