Hospitals and healthcare organizations around the globe are undergoing a transformation as they move slowly from a volume-based model to a value-based paradigm. The industry is challenged by inefficiencies, errors, sub-optimal clinical outcomes and out-dated evaluation techniques as it produces enormous amounts of data. Building analytics competency can help this industry harness “big data” to formulate actionable insights, set its future vision, improve results, reduce time-to-value and ultimately deliver better patient care. DataSmart Solutions (DSS) is playing a significant role in bridging the gap between data analytics and lower cost with higher quality by offering data analytics to essentially every segment of the healthcare industry.
DataSmart Solutions is a healthcare-facing data warehouse and analytics company perfecting the reliability and strength of its storage infrastructure and the value of its analytics in terms of saving money for customers. The company has developed algorithms to search through massive amounts of information, to analyze and interpret the data, and predict the probable cost and health conditions of individual patients within a population.
Twenty-two years ago, Paul Bogumill, President & Founder of DataSmart Solutions, organized the core team of experts and laid the foundation of the company. Paul’s training is clinical, although his career path has steered him steadily toward the management of partially self-funded health benefit plans where he observed a dire need for supportive analytics. Jonathan Prince joined DataSmart Solutions as CEO in early 2015 to provide oversight and a roadmap toward the full commercialization of DSS’ core technologies. Jon has over 35 years of experience in business management and innovation through technology.
Unified Solution for Healthcare Analytics
DataSmart offers a platform called the Client Solution Tool (CST 3.0) for consultants, brokers, and advisors which assists them in identifying plan participants at risk of becoming high-cost claimants in the next 12 months. Clients can evaluate plans, providers, facilities, and medication usage. The platform also supports actuaries in calculating stop-loss premiums as well as case managers in managing their workflow. DSS’ current Client Solution Tool is oriented toward partially self-funded employer benefit plans and case management professionals. “The tool was designed by benefits professionals for benefits professionals,” maintains Bogumill. The most distinguishing characteristic of CST 3.0 is the incorporation of many data elements beyond mere claims information. The broader set of data amplifies the predictive power of the analytics substantially. Compared against other vendor alternatives for most mid-size and smaller plans, DSS management believes this is the most powerful commercially available risk management tool in healthcare.
Continuous product improvement leads to better results and successful clients
While discussing how good strategies are paying off, Prince says, “Without being too specific, let me share that we are poised for a significant improvement in the modeling power and risk scoring ability we deliver to our clients. We attribute this particular improvement more to our use of better data sets than to technology advances, per se. However, as we advance further in identifying available, non-clinical data elements with high statistical value, we are also utilizing emerging technologies to deliver the results much faster than before. More concisely stated, our next move will be another increase in predictive power derived from new non-claims data sources which we will deliver through tools featuring more usability.”
Prince believes that version 4.0 of the CST (due late 2016) will set DataSmart further apart from mid-market competitors. Faster speed, simpler reports, more actionable information, and improved data accessibility will make the work of consultants, brokers, and case managers easier than ever.
The company is moving steadily from a ‘product company’ to a strategic partner. This transition is attracting the consulting and brokerage industry giants. “We aspire to see our analytics improve the health of a significant percentage of the US labor force, and our strategic partnership culture is getting us there. Meanwhile, our business currently rests on a large book of small employer plans (50-500 EE) which is our bread and butter and where we learn what we know today about client satisfaction,” asserts the CEO.
According to Prince, to contract with an analytics vendor is not enough. Plan managers and their brokers must create an organizational infrastructure (whether large or small) that will place responsibility for acting on the analytics on a single point of accountability. We are not interested in working with companies that only want colorful reports with attractive bar charts and trend lines. We want partners who will dedicate resources to use these tools and impact the health of their plan participants. We take the improvement of healthcare seriously and see a bright future in the USA for a more efficient healthcare industry, provided the analytics are acted upon.
