Leading the value-based care conversation

Innovation Gives Data Vendors the Opportunity to Prove Themselves in Today’s Healthcare Market

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Remember when the doctor dusted off a paper copy of your medical record ahead of an office visit? While the days of medical record isolation are long gone, data remains a critical part of today’s healthcare market.

Whether we like it or not, most states now have at least one Health Information Exchange (HIE) connecting clinical records across local areas and are moving quickly to further integrate with payers and other government healthcare organizations. Imagine a world of full-service health and wellness that integrates clinical, claims, and social determinant data. It’s available now! And with the push towards a unique patient identifier it will only be a matter of time before the nation’s records are tied together seamlessly, with no regard to your location or situation. Let me appeal to your imagination.

If you live in California and visit an emergency room in Kansas? No problem. The doctor will simply log in to an integrated system to view your medical history in order to provide quality care.

Having problems getting a well-balanced meal or a place to sleep? No problem. Your care coordinator has sent your name to Meals on Wheels, and the local housing authority will be reaching out to help you. Oh, by the way, here is a list of food pantries in your area.

You are a payer and monitoring fraud, waste, and abuse? No problem. Here is a list of potential system abusers (provider or member - take your pick).

Opioid abuse and medication therapy management? No problem.

You’re a government agency monitoring your contracted MCOs? No problem. Here are their quality measure results in real-time. MLR stats? No problem. Value based arrangement analysis? No problem.

The scenarios are endless.

With the amount of information that is available for integration today you can feel overwhelmed with the task of whittling down what is necessary to drive your mission and goals. Simply connecting the dots from one type of file to another type of file can seem daunting while we ask questions like these:

How do local codes and modifiers equate to another state’s requirements?

This payer requires bundled billing, but another payer requires line item billing. How can we compare?

Billed amounts were paid by a primary payer and now we have a third-party billing scenario with contractual obligations. How can we maximize revenue?

How do we handle privacy and a member’s ability to opt-out of sharing information?

How do we now create policy and processes to help high emergency room utilizers?

These questions are endless.

What a great opportunity for vendors to prove themselves today! Collecting and housing every conceivable piece of data isn’t enough. What is important however, is the ability to aggregate and show that data in a meaningful and impactful way. Whether you are a provider, provider group, health insurer, or government program, the need for intelligible analytics across the spectrum is a huge need today.

Ask the tough questions of your data vendors. Vendors using cutting edge AI technology can deploy and provide your customized meaningful analytics needs in a very short turnaround time. Stay focused and measure what matters to you.

The future has arrived.

Author: Lori Lawson
Date of Publishing : 11/1/19 10:27 AM
Lori Lawson, MBA, CHFP is HealthEC’s customer account manager for District of Columbia area customers and a former deputy director of South Dakota Medicaid.