With the Affordable Care Act here to stay, healthcare is in an irreversible transition from volume-based to value-based care. By integrating both clinical and claims data, provider organizations will have the robust dataset required to measure quality and identify at-risk patient populations.
Many healthcare organizations today rely too heavily on claims data. Claims data, despite being highly structured, does not show the full picture of the patients in their care. With claims data alone, providers will only get so far when focusing on population health management. EHR systems can provide a wealth of data not typically found in these claims sources, such as problem lists, lab results and vital sign measurements.
Having an integrated data set that combines both claims and clinical data is crucial, as it allows providers to manage patients across the entire care continuum, while giving them the ability to leverage the level of detail captured in the EHR. Further, managing a population solely on claims data is ineffective, as there is at least a 30-day lag before claims data is available, while EHR data is real-time.
True population health management requires systems level thinking, vs. thinking about lots of individuals. Systems level thinking requires the integration of data from all EHRs across the entire system to give a more accurate view of the organization’s patient populations. However, the process of taking vast quantities of claims and clinical data and turning them into actionable, meaningful insight is highly complicated. Organizations looking to undertake these efforts and/or partner with a technology firm to do so, should consider that many vendor-supplied extracts and interfaces, like Continuity of Care Documents (CCDs), often fall short of giving the actionable data needed to drive change within their organization.
In order to ensure the proper integration of clinical and claims data, be sure to:
1. Gather all necessary data and metadata – Mine data from actual EHR tables, rather than relying on vendor-supplied sources like CCDs or APIs, which often provide incomplete views into your data.
2. Expand the dataset – Go beyond traditional data extraction methods to find both structured and unstructured data to be able to truly define a patient population.
3. Map to custom workflows – Request a reference library of mappings, code-sets, and translations that identifies structured and unstructured elements. The library should use LOINC, CPT, RxNorm/NDC or other codesets to establish the most structured form of documentation
4. Build a trusted dataset – Ensure your data is secured with the latest encryption and data protection. Data should be encrypted both at rest and in transit and able to be integrated without needing an open special firewall or security configurations.
Some healthcare organizations are slowly starting to understand the importance of EHR data in meaningful population health management initiatives. According to a new poll by Black Book Rankings, almost twenty percent of providers from large ambulatory clinics are in the discussion or execution stages of replacing their EHR to access better interoperability and patient engagement tools and improve population health management.
By aggregating patient data from all EHRs and unifying it with all relevant data sources, including insurance claims data from local and national health plans, an organization can create a central utility to compare cost, quality and efficiency metrics. This allows providers to track trends and preventative care, identify health disparities, and help patients manage chronic medical conditions, all of which are critical for meaningful improvements in population health. However, it is the transformation of this data into meaningful insight that will allow them to thrive in this new era of healthcare reform.
In his role, Dr. Parker provides strategic and clinical expertise to Arcadia’s clients managing the transition from a fee-for-service to a fee-for-value environment as well as internal product and engineering teams as they continue to develop the market-leading Arcadia Analytics technology platform. Prior to joining Arcadia, Dr. Parker served as Chief Medical Officer for the Beth Israel Deaconess Care Organization (“BIDCO”), a value-based, physician and hospital network headquartered in Westwood, Massachusetts. During Dr. Parker’s tenure, BIDCO was the highest performing Pioneer ACO in the Commonwealth of Massachusetts and ranked third nationally in the 2013 reporting year. Dr. Parker’s medical specialty is internal medicine, practicing within the Beth Israel Deaconess system for 27 years. Dr. Parker earned an undergraduate degree from Harvard University, and did his medical training at the Alpert Medical School at Brown University and the Geisel School of Medicine at Dartmouth College.
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