Healthcare decision makers are challenged by new strategic imperatives to measure clinical performance; not optimal billing strategies with tools focused on administrative data, clinical data. Q’s interoperable and connected health technology links all data, applications and processes to provide access to electronic, comprehensive EMR patient records, disparate vendor databases and real-time analytics.
Q’s first-to-market clinical intelligence software is the complete solution for healthcare providers, payers, employers, and insurance companies seeking to achieve optimal clinical, financial and operational efficiencies and outcomes. Q is the proven and experienced clinical performance and outcome analytics and solutions company in American healthcare.
Strategic Imperatives Demand Clinical Performance Measurement
Performance measurement is required by the Joint Commission for Focused and Ongoing Professional Practice Evaluation (FPPE-OPPE) and now is critical to transition to value-driven revenue as pay-for-performance. Performance measures combined with outcomes measurement related to patient-specific risk factors is the innovative technology. Clinical variables with Q’s analytics tools embedded in QualOptima make our tools different and precisely matched to the imperatives facing leadership in coordination with clinical practitioners. Leadership in coordination with clinical practitioners urgently need QualOptima to link all clinical data, applications and processes to provide access to electronic, comprehensive EMR patient records, disparate vendor databases with embedded clinical content and metrics for real-time and retrospective analytics.
Clinical Knowledge Solutions / Identifying Causes Not Just Rates
Healthcare analytics and health data science must advance from merely calculating rates, such as rates of maternal complications. Technology and analytics prior to QualOptima have relied on large healthcare databases, such as HCUP (AHRQ) and MedPAR (CMS), based on claims data, or hospital products using administrative data. What has been missing is creation of a provider-specific clinical database from existing but disparate databases. QualOptima develops a common data platform for integrated clinical data with specific patient risk factors for analytics using state-of-the-art health data science tools and methodologies.
Instead of analytics for comparisons based on complication rates, for example post-partum hemorrhage after delivery in obstetrical services, QualOptima tools and methodologies use analytics to identify root causes of such hemorrhages. Analytics of post-operative nausea and vomiting not only calculates rates down to the specific provider or use of antiemetic medications, QualOptima tools search specific risk factors and combinations and dosages of antiemetics to identify actionable insight for optimal clinical processes for optimal clinical, operational and financial outcomes. Q’s business model is not just the technology; clinical knowledge solutions have been the focus of our engagements in health care for over 35 years.
Liability Exposure for Failure to Measure Clinical Performance
Performance measurement is required, and organized medicine recognizing impending value-based payment is rapidly publishing numerator/denominator specifications in hundreds of performance measurement sets. These metrics are significantly different than measures hospitals and physicians are using in their processes for clinical integration and other optimized billing initiatives with software products.
Less than 15% of essential clinical data for performance measurement is in structured data fields. Machine learning technology of QualOptima captures and integrates unstructured data from narrative text. This unique QualOptima tool integrates numerator and denominator data from both types of data sources into the Qualytx database. QualOptima’s embedded clinical content and metrics for performance measures sets is then imposed by Q’s analytics engine. And the data is patient-specific with individualized risk factors. Impending liability exposures for failure to measure clinical performance will result in even more aggressive negligent credentialing claims and litigation. Opportunities from joining multiple plaintiffs with the commonality of failure to measure performance in credentialing, especially in states with vigorous capitation limitations, will further serve to foster liability exposure.
Competitive Advantages with Value-Based Performance Measurement
Healthcare organizations are rapidly facing the pressures of competing on performance with significant financial incentives based on value (quality + cost). The competitive advantage balance sheet has two sides, negative and positive. On the positive side of the ledger, QualOptima is the ideal choice for healthcare providers and payers whose strategy is to market on performance and outcomes. High-performing organizations are marketing demonstrating their quality, not just organizationally but by service and specialty-type.
The days of gimmicks and contracting with companies to “evaluate” their performance are over. The negative side of the competitive advantage balance sheet results from highly- publicized bad outcomes; next it will come from publication of outcomes data identifying specific complication rates for hospitals and physicians. Transparency and public reporting of performance and outcomes-specific data is rapidly becoming available to patients and payers as health data analytics tools for identifying low-performing performers become widespread.
Pay-for-Performance Metrics and Analytics
QualOptima is laser focused on the 26 measures that will be used in 2015 by CMS for value-based purchasing (VBP). They include 12 clinical process-of-care measures (for example, whether surgical patients received venous thromboembolism preventative care), eight patient-experience dimensions (such as doctor & nurse communication), five outcome measures (including 30-day mortality rates for heart failure, pneumonia and heart attack); and one efficiency measure on spending/beneficiary. QualOptima’s unique technology using patient-specific risk factors solves many of the concerns from limitations of “risk adjustment” in complex healthcare value analytics.
Value-based purchasing (VBP) refers to a broad array of performance-based payment strategies linking financial incentives and penalties to provider performance across all healthcare settings. VBP is central to efforts of Medicare to drive improvements in quality and slow health care spending using a set of defined measures to achieve better value. The Accountable Care Act (ACA) focuses on bad outcome, no outcome, no income.
Until 2015, pay-for-performance (P4P) payments were limited to relatively small incentives. Now physicians and hospitals are waiting to see if their payments will be reduced by penalties or increased by P4P incentives. As these payment programs are implemented and subject to change, QualOptima metrics and analytics are the solution not only for enhanced revenue but for optimal clinical processes and outcomes that will have significant impact using data-driven solutions for results-driven success. Q’s embedded analytics tools focus on the total array of performance measures, not only P4P but for organized medicines performance measures sets as well as target performance metrics, for example to identify and decrease low-value services to achieve cost-conscious care published for internal medicine.
Integrating Nursing Care Plans with Performance Measurement
Performance measures sets for in-patient hospital care are frequently done by nurses, both from carrying out diagnostic and treatment protocols as well as physician orders. For example, prevention of catheter-acquired urinary tract infections (CAUTI) involves primarily nursing performance. Hospital-acquired infections (HAC’s) not only subject hospitals and physicians from non-payment for certain HAC’s, but more than 50% of preventable hospital deaths result from HAC’s. While experts for some of the alleged competing products speak publicly about not being concerned with HAC’s because they are a small percentage of revenue, that thinking is not only antiquated and not ready for value-based purchasing impacts, it demonstrates the lack of focus on optimal clinical outcomes and professional responsibility to first do no harm.
QualOptima incorporates nursing performance and integrates clinical data from nursing care plans and tracking performance against care plans for patient management.
Personalized Individualized Clinical Performance
QualOptima performance and outcomes analytics are one of the strongest features of the system. QualOptima measures clinical performance and outcomes in the scientific context of embedded risk factors. The first-to-market difference is patient-specific risk analytics, which is essential in complex health care measurement of performance and outcomes, not “risk adjusting.” Q is engaged in identifying and adding fitness factors favorable to outcomes, as well as negative factors of patient-specific risk, which will facilitate the use of QualOptima for wellness and providers and payers working with patients engaged in the health and for their health care.
One Size Does Not Fit All in Population Health
Health systems and providers, as well as payers, must inevitably focus on the chronic conditions responsible for five percent of the patients that are responsible for 50% of health care expenditures and costs in America. QualOptima analytics and product deliverables use personalized and individualized risk and fitness factors to adjust optimal clinical processes to specific patients. Accountable Care Organizations (ACO’s) and other healthcare providers whose revenue model is significantly focused on population health are ideal customers for QualOptima technology.