Healthcare organizations face the critical challenge of understanding the true cost of patient care. This knowledge is vital for making data-driven decisions that enhance both patient outcomes and the financial stability of the institution. The Alithya Cost of Care solution addresses this challenge by offering a robust and scalable platform that integrates diverse data sources, including electronic health records (EHR), workforce management systems, payroll systems, and general ledgers – ensuring seamless healthcare data integration.
A scalable and integrated solution for cost of care
Alithya empowers healthcare organizations with advanced analytics for cost of care with a scalable and fully integrated platform based on standard modern data architecture and leveraging Oracle's cloud-based healthcare solutions for data management, costing, and analytics capabilities. This architecture provides granular cost analytics, including the ability to analyze costs and payments as service lines, encounters, charges, and payment levels, empowering healthcare providers with deeper insights into profitability, operational efficiency, and the quality of care delivered.
Key features of Alithya Cost of Care Analytics
This article will briefly review the key data architecture and management features underpinning this powerful analytics engine, ensuring scalable healthcare analytics for organizations of all sizes. Subsequently, we will delve into use cases that demonstrate the valuable insights generated by the Alithya Cost of Care solution.
Scalable data model and architecture
A pre-defined, standardized data model and structure are designed to support a range of costing and profitability functionalities, including advanced analytics while adhering to standard modern data architecture. The solution can also compartmentalize ingested data and curated analytical data, providing the flexibility to extend the model and configure additional elements, data sources, and data processing with limited impact on out-of-the-box methodologies and analytics.
Integrated data collection and processing
The data integration engine facilitates seamless data ingestion, transformation, processing, and curation. Users gain the ability to effectively manage and configure data dependencies, processing sequences, and scheduling. The solution prioritizes data quality and completeness throughout the entire process with effective healthcare data integration for more accurate and actionable insights. Built-in mechanisms alert users to any missing data or inconsistencies that could potentially impact costing accuracy, calculations, or the reliability of analytics. Furthermore, the data processing engine is built upon a foundation of Enterprise Cloud Relational Data Warehouse products. This provides inherent scalability to support large data volumes while ensuring optimal performance and reliability.
Configurable product and service line rule engine
The rules engine is used to dynamically create and maintain rules to define new product or service lines based on various criteria. It also supports costing methodologies by allowing users to select key standard clinical data elements and define specific conditions for each data element. Additionally, it allows users to combine multiple rules to create complex logic to reflect the products and services offered at your institution. The rule engine applies the defined rules to assign service lines at the lowest granular level of data, providing the ability to analyze costs and profitability at both individual service line and grouped service line levels, driving data-driven decision processes across healthcare operations.
Advanced costing engine
The Alithya Cost of Care solution's robust costing engine leverages the power of Oracle Enterprise Profitability and Cost Management (EPCM). The pre-built costing engine supports a variety of costing methodologies (e.g., RVU, RCC, ABC) out-of-the-box and can be configured to accommodate multiple cost drivers, enabling advanced medical cost management. Fully integrated with the Cost of Care platform, the engine calculates cost rates, which are then utilized to determine key profitability KPIs and conduct detailed encounter-level cost analysis. The granular costing features combined with AI insights result in more accurate financial reporting, budgeting, planning, and forecasting. A more in-depth exploration of the costing engine's capabilities and the calculated cost data will be the focus of the next blog post in this series.
Advanced analytics and reporting
While advanced analytics and self-service reporting are essential for any comprehensive cost of care solution, the lack of truly actionable insights, supported by complete and detailed data, remains a common challenge for many users and healthcare organizations. The Alithya Cost of Care Analytics platform is fully integrated, featuring pre-built cost of care and profitability KPIs, visualizations, and analyses. The platform provides actionable information to help key users understand costs, profitability, and address critical questions, such as identifying the most profitable service lines or providers or identifying outlier encounters or procedures that cost significantly more or less than similar encounters or procedures. Furthermore, the analytics platform empowers users with full self-service capabilities, empowering them to independently create and analyze data. It also includes pre-built support for advanced machine learning and AI analytics, facilitating the development of predictive healthcare analytics models and more sophisticated insights.
Alithya Cost of Care Analytics use cases
Service line analytics
Analyze service line profitability by aggregating encounter and non-encounter cost measures (e.g. revenue, direct costs, fixed/variable costs). Service line analytics enable drill-down analysis by provider, organization, location, charges, supplies, and other dimensions with over 40 cost-related measures to identify areas for improvement.
- Example: Investigating declining profitability despite high patient volumes
- How Alithya Cost of Care Analytics helps: Service line leadership can use the system to review key metrics across multiple service lines over a user-selected period. They can then drill down into individual encounter data to pinpoint the source of the problem and identify opportunities for improvement.
Encounter charge analytics
Get actionable insights by categorizing and filtering financial results from EHR data. Encounter charge analytics facilitate the analysis of encounter cost variations, potentially revealing issues such as underbilling or utilization discrepancies. Conduct contextual analysis of related diagnoses, procedures, supplies, and medications by leveraging integrated patient data.
- Example: Comparing costs among providers in similar roles
- How Alithya Cost of Care Analytics helps: Encounter dashboards can enable department managers to identify high- and low-cost providers and analyze the underlying reasons for these differences. By examining cost measures like charge code, fixed variable, direct, and indirect costs and considering factors like diagnosis and procedures, managers can develop targeted strategies to manage costs more effectively or increase revenue.
Payment analytics
Optimize contract management by analyzing payments related to specific procedures and provider groups. Identify potential underpayments from insurance carriers and inform contract negotiations with detailed cost data.
- Example: Analyzing payments for a specific procedure over a year to identify discrepancies.
- How Alithya Cost of Care Analytics helps: A financial analyst can compare the year over year aggregate payments by insurance carrier. If a carrier's payments have changed significantly, the analyst can further investigate payments using encounter-based attributes like primary diagnosis to find opportunities to update carrier contracts to better align payments with costs.
Move the needle with Alithya's Cost of Care Analytics
The Alithya Cost of Care solution empowers healthcare organizations to effectively utilize existing cost data for informed decision-making across the enterprise, eliminating the need for ad-hoc projects and driving continuous improvement in financial performance. Contact us today to start your healthcare transformation journey.