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Much has been written about the ways in which “big data” concepts are likely to affect hospital operations, by increasing the detailed understanding of all activities taking place in the hospital and community and allowing more comprehensive management strategies to be put in place.
Given that the health insurance marketplaces, or exchanges, for the Affordable Care Act (ACA) have been preparing for the Oct. 1 “go live” date, it is useful to explore how the exchanges are likely to affect communications and data demands to be placed on hospitals.
The exchanges are essentially data processing centers. These centers are linked to a "Data Services Hub," which functions as a large, complex switchboard, linking the Exchanges to various federal agencies that must support exchange operations.
At the same time, employer reporting requirements are increasing, while insurance companies and hospitals are also becoming essential parts of this network, with information to be constantly passing back and forth with the exchanges.
“Big data” concepts are probably going to become much bigger than now anticipated.
As the exchange networks get past the initial challenges of meeting basic functions, it may be expected that they will begin to broaden their activities to create their own “big data” environments.
More demands will likely be placed on hospitals to report operational information and act on new types of received information. Comparisons among facilities and standards are inevitable, along with demands for deeper levels of justification for services and costs.
Thus, hospitals will be placed in the “overlap region” between the exchange big-data networks and hospital-based big-data networks that reach out to surrounding communities. As hospitals seek to expand their own big-data concepts, they will be increasingly incorporated into health insurance exchange big-data networks.
Hospitals therefore need to think about how their information-processing systems are likely to grow, and allow for designs that will not present problems as big-data systems begin to overlap. Provisions need to be made for a large number of inputs from the outside world to hospital-based data processing systems, combined with provision for extensive transmissions of data back to the outside world.
The end result is likely to be increasingly higher levels of interaction between hospital networks and the exchange networks. It is not unreasonable to think that the day may come when the exchange networks monitor all patient services and charges in almost real time, and provide a constant flow of critiques, denials, and approvals.
There can be a large loss of control by hospital administrators in such circumstances, unless careful thought goes into how such an intrusive environment is to be handled.
It is hard to envision now the level of transparency that may result for hospitals in the rather-near future. And this transparency will extend to surrounding communities, as the exchange networks provide information back to communities about hospital activities.
As the Exchanges become operational, it is important for hospitals to look ahead to the ways in which information networks may evolve, and consider how their interests may best be protected.
It may be useful to help guide exchange requirements as much as possible during the early stages of evolution, rather than wait for directives to be given.
Publication Date: Friday, October 04, 2013
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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