A view from the Center

Deloitte's Life Sciences & Health Care Blog

Untie the Gordian Knot, knit together a collaboration

I am a big believer that many of the intractable problems we face today can be solved through a diverse and collaborative effort that includes a cross-sector of industries, public and private collaborations, and partnerships between nonprofit and for-profit organizations. I believe only when we break the constraints of an existing system are we able to imagine new and innovative ways to solve our collective challenges. This is true for most everything… including health care.

At Deloitte, I am proud and privileged to champion the RightStep program – a unique initiative, part of the Strive for College organization, that seeks to empower and motivate underprivileged students to become future leaders – starting with a college degree. This is a multi-faceted initiative that taps Deloitte’s most powerful asset: our people. Through skill-based volunteerism and mentoring, our team members help students from low-income families prepare for and enroll in college. There are 500,000 low-income students around the country who could attend college this year, but won’t pursue it for variety of reasons.

This year, more than 170,000 students will seek a mentor from Strive for College. This nonprofit organization has a virtual platform that matches students with mentors who help students navigate the college search and admissions process. Based upon Strive’s analytics, 97 percent of the students who are matched to a mentor wind up enrolling in a college, and 80 percent persist into their sophomore year.

The societal impact of intergenerational poverty keeps too many low-income children from going to college, finding a career, and reaching their potential. The numbers are staggering. While this is an intractable problem, the collaboration between Strive and leading companies that tap into their own pools of talent can positively impact hundreds of thousands low-income students. Imagine the possibilities if we extend that idea to health care.

Can health care collaborations break the constraints?

Similarly, the health care sector faces a dilemma that could be solved, or at least improved, through collaboration. In a recent survey, hospital CEOs told us that moving to value-based care and improving population health are two of their biggest challenges. Value-based care is also a major focus for health plans. Clinical analytics – which includes value-based care and population health – is now the largest investment category among health plans, according to a recent online survey of company executives, which is included in our new report on health plan analytics.

Many health plans are increasing their use of analytics to boost the value of their products and services. However, just 16 percent of our health plan respondents stated that collaboration with providers was a driver of their analytics investments. In our interviews with health care providers and health plans – and based upon our own experience – we confirmed that analytical insights are largely not being shared in most value-based contract arrangements.

Through the use of advanced analytics, health plans can analyze everything from value-based contracts to potential fraud and abuse. They also can create detailed insights into population health and social determinants of health. While these analytics can allow health plans to develop an impressive list of tools, not sharing their insights with network providers and value-based contract participants seems like a missed opportunity.

The data health plans collect isn’t as rich as it could be, and is largely confined to information generated by claims, eligibility, and encounters. It typically doesn’t include information about outcomes, patient satisfaction, wellness, or clinical data. In addition, the performance improvement desired by subscribers and employers often requires a more holistic view of the patient, which likely is not possible without information and insights from the clinical, the claims, and the patient. Health care providers could fill that gap by helping to form a complete picture.

Health plan executives provide good reasons why they don’t share analytics with providers. These include regulatory and competitive constraints, challenges related to patient attribution, lack of a master patient identifier, and technology that limits their ability to share insights at a scale to match their network size. There also are potential alignment issues that come up in the provider relationship.

These significant challenges may seem intractable in their own way, especially if each silo in the health care ecosystem tries to solve it on their own. But, being a big believer in collaborations, I don’t see these as insurmountable problems. All of the executives we interviewed agree that real success is only going to be sustainable when the health plan shares its data insights with clinical care delivery teams, and the clinical delivery teams shares their data insights with the health plan.

Collaborations between health plans, health systems, and physicians are being established in virtually every market, and are gaining acceptance as a model that might work. In the context of the Medicare Access and CHIP Reauthorization Act (MACRA) and the adoption of alternative payment models in Medicaid, the ability to improve performance and make health care more affordable may rely heavily on measuring, tracking, and finding new insights.

Imagine the possibilities when health care providers understand where the adverse variances are occurring and are able to find ways to innovate their processes, or identify new models of care that lower cost by improving access and patient engagement…or a health plan that creates a new plan design that encourages wellness. Breaking constraints isn’t easy, but the existing challenges can’t be solved without a commitment to collaborations.

And speaking of collaborating…if you want to make a difference in a very tangible impactful way for one of the 170,000 students who is looking for a mentor like you to help them get into college, feel free to learn more about our collaboration with Strive for College.

Author bio

Bill Copeland, Vice Chairman of Deloitte LLP, is a 27-year Deloitte veteran and leads the US Life Sciences & Health Care Practice. Previously, Bill was practice leader for the health reform initiative, focused on serving clients’ needs around the incredible changes resulting from the Affordable Care Act. He was also National Managing Director of our Life Sciences & Health Care Industry Consulting Practice and managed the Health Plans Consulting Practice.