Vijay Pattabhiraman was named Neighborhood Health Plan of Rhode Island’s vice president of health care analytics in July. He joined Neighborhood Health in 2019 as director of risk adjustment, a role that required ensuring the organization’s risk adjustment initiatives were in compliance with the Centers for Medicare and Medicaid Services and Rhode Island regulatory guidelines.
Pattabhiraman, who has 25 years of experience working with data for health care organizations, discusses some of his new responsibilities and the impacts of data analysis on Neighborhood Health members.
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PBN: Please explain briefly what some of your main responsibilities are as vice president of health care analytics.
PATTABHIRAMAN: First, let me say how honored I am to play such a critical role at Neighborhood. Using data to inform decision-making is important across all industries, but to me, applying data analytics at a health plan that serves the state’s most vulnerable populations is especially meaningful. It’s a big responsibility and one I don’t take lightly.
The members we serve and the providers who care for them are on my mind each and every day – they are what drive me to extract every piece of information I can from data to improve health outcomes, as well as health care experiences. That said, some of my key responsibilities as vice president of health care analytics for Neighborhood includes translating data into actionable insights to positively impact the health outcomes of our members and how providers are delivering services.
A key part of my role has centered on establishing a framework for data collection and analysis, and positioning the analytics team as a strategic thought partner to the organization with a strong emphasis on insights and interpretation. The analytic capabilities we’re developing include clinical, population health, operational, risk, financial, provider and predictive modeling. I deliver that information in a way that empowers decision-makers with insights that drive business actions.
Put simply, I turn information into a strategic asset for Neighborhood.
PBN: Are there some examples you could give of how data analysis has translated into decisions that directly affect Neighborhood members?
PATTABHIRAMAN: Absolutely. I’ll provide examples that offer a few different perspectives of the value that data analysis brings to our members.
The risk analytics capability we developed helps Neighborhood gain insights to continuously improve the way we work. This in turn leads to informed revenue optimization activities and ensures compliance with the Centers for Medicare and Medicaid Services – the federal agency that administers the nation’s major health care programs – and with Rhode Island regulatory guidelines. This level of commitment shows in Neighborhood’s long history of excellence – earning us consistent high marks from national accreditation organizations like the National Committee for Quality Assurance.
Statistical analysis of our admin and nonadmin data is another example illustrating the correlation between analytics and business decisions that directly affect our members. This type of analysis enables an accurate understanding of illness burden of the members we serve. Through clinical identification, stratification and member risk analysis, Neighborhood is able to accurately capture the risk profiles of members in our Medicare-Medicaid Product – known to our members as INTEGRITY – and of members in the Affordable Care Act population of our commercial line of business. The inferential analysis allowed us to strongly correlate the CMS reimbursement with the health status of our members. The risk analysis helped validate that these members received all the appropriate services and that the provider interactions associated with these services were accurately documented.
The data analysis also helped us align the member-predicted costs to the actual costs of serving our members, drive actions to accurately align utilization of medical services to the revenue and to identify our high-risk members for member interventions. The latter allowed us to close gaps in care to drive optimal health outcomes. The analysis also helps to control investment calibration across member interventions and allows Neighborhood to determine the return on investment of various member intervention activities.
PBN: You’ve spent about 25 years in analytics – what is your take on the importance of data analysis as it relates to the average health plan member?
PATTABHIRAMAN: Data analysis is critically important to all health plan members, especially in light of the ever-changing health care landscape. Over the past decade, for example, the landscape has changed tremendously with COVID-19 exacerbating existing challenges.
Before the pandemic, there had been a paradigm shift in the health care landscape due to the growing epidemic of chronic diseases, as well as a demographic shift to an older population and increased life expectancies. All of this impacted the costs and demands for health care services.
At the same time, the health care insurance market was undergoing a dramatic transformation. The Affordable Care Act introduced in 2014 increased the number of patients with health insurance – further growing the demand for health care services. Now, given the unwelcome entry of COVID-19, the demand for health care services has increased further, worsening the situation.
For the first time in my adult life, Medicaid is the largest payer (70 million lives) followed by Medicare (63 million lives) and ACA Commercial (21 million lives) among the government programs.
Meanwhile health care providers and health care systems are under pressure to improve patient health outcomes while reducing costs, serving a greater number of patients, accounting for a higher prevalence of chronic conditions, adjusting to changing lifestyles of the population, coping with technological changes and integrating growing amounts of digital data into clinical practice.
This is where I think that leveraging data and statistical analysis to get higher-value results will be the game changer and, ultimately, what will differentiate us from our competitors.
At Neighborhood, we serve 1 in 3 Rhode Islanders, with a high proportion of our members deemed as being at-risk. So it is imperative that we impact people’s lives through evidence-based decision-making that drives activities to influence an optimal health outcome.
Value-based care will continue to be the biggest disruptor in health care for decades to come and is one way to attain lower health care costs without sacrificing patient outcomes. Data analysis and analytical modeling are critical to achieving the desired results. Moving forward, there will be a greater emphasis on standardized processes and increasing integration of data scientists into the health care mix.
PBN: How do you foresee analytics contributing to the identification of growth opportunities for Neighborhood?
PATTABHIRAMAN: The future health care market will be driven by predictive, preventive, personalized and participatory care, and Neighborhood is poised and ready for this. Our analytics function empowers data-driven decision-making and is integral to the fulfillment of our mission.
Digital technology, value-based care and member centricity are the drivers for this paradigm shift. Health care is no longer just about access, quality and affordability. It is also about the predictive, preventive and outcome-based care models promoting social inclusion. Data analytics will contribute immensely to this transformation.
The key areas of analytics driving this growth opportunity include population health, risk analytics, financial performance, product profitability, value-based care, outcome-based reimbursement programs, aged-care, chronic conditions care management, and operational process standardization and efficiency.
Plus, with data becoming cheaper than ever to capture and with technology becoming more open-sourced due to the advancement in artificial intelligence, the competitive advantage of data proprietary is slowly eroding. As this trend continues, Neighborhood will leverage the opportunity to capture the data in a seamless manner, analyzing it ourselves and collaborating with stakeholders to share insights and analysis.
The key mantra for Neighborhood is to measure, optimize and transform using the analytic capabilities on how we do things. Data analytics will lead us to reduce costs, improve quality and ensure that members are receiving optimal care at a reasonable price in a timely manner. Analytics will enable Neighborhood to adapt to a new landscape where change is fueled by data and technology.
PBN: During your time as Neighborhood’s director of risk adjustment, you created a risk adjustment team and developed valuable collaborations with stakeholders. Do you expect to take on any similar projects in your new role?
PATTABHIRAMAN: Absolutely, yes. The analytics team is currently developing a Program Evaluation and Design of Experiment framework in collaboration with our internal stakeholders to influence the desired health outcomes for various lines of business, including Medicaid and Medicare-Medicaid products.
We are expanding the scope of risk analytics developed primarily for driving risk adjustment activities to now be employed enterprise-wide in order to drive other organizational activities that influence the health outcomes of our members. We are also developing a dashboard to understand cost trends within our behavioral health cohort for various lines of business.
We are also in a planning stage for developing risk adjustment heuristics and gaps in care methodology using data from our pharmacy team, developing a framework for measuring the efficacy of interventions and developing a provider scorecard.
We have an impeccable altruistic team at Neighborhood who are driven by purpose to serve the at-risk population. I am highly confident that the work we do will continue to influence improved health outcomes for our members.
Elizabeth Graham is a PBN contributing writer.
