In recent years, healthcare payers have realized that not only is clinical data a necessity, it will soon play a key role in incentive payouts. Previously, payers have depended on claims data and the limited amount of clinical data on claims forms to construct care management applications and manage programs intended to reduce costs.
Incoming claims data is the basis for member outreach programs for a high-risk patient diagnosed with a chronic illness. It may take a month or more for any type of hospital visit to be disclosed. Additionally, member information from the hospital omits historical medical records and crucial signs that would help the payer pinpoint high-risk patients or improve its outreach.
Clinical & Financial Data Integration
Healthcare payers now understand that gaining access to clinical data and leveraging it is a must for incentive payout. Recently, Healthcare Effectiveness Data and Information Set, a quality reporting program, has tried to convince payers to use more patient-centric approaches when managing their members. The majority of these approaches call for more access and use of clinical data in order to minimize adverse reactions and reduce lab tests, scans, and various other repeated clinical procedures.
The Clinical Data Obstacle for Payers
Even if clinical information can be accessible for payers, integrating this data with their own systems and making it actionable comes with several obstacles. The obstacles with this payer-provider partnership include:
- Incompatible Systems: In most cases, payers don’t have systems that are able to aggregate and leverage data. These system workflows cannot access and consume this information or integrate it with their own sources of data.
- Conflicting Clinical Data Aggregation: The IT infrastructure of most payers often involves a number of different applications and runs on several technologies at any time. It must meet the needs of a variety of incongruent sources of data like imaging systems, national registries, and telemetry.
- Terminology Gaps and Clinical Data Quality: Although payer systems have been strict about adhering to industry standards, provider systems still find compatibility a challenge. The challenge stems from the number of electronic transaction standards and clinical terminology.
How to Overcome Integration Obstacles
In order to overcome the obstacles of the payer-provider relationship, organizations must start by pinpointing use cases with high impact and prioritizing applications based on the criticality of the use cases they’ve identified. Next, they should develop a Master Patient Index that will serve as the key for a customer data mart. Adapters that utilize data from EMRs, pharmacy systems, and other clinical applications can ensure proper integration.
Converting Clinical Data to Actionable Insights
To convert clinical data to actionable insights, business decision makers need to clearly outline their uses cases and requirements. In addition, the aggregated data should make it possible for payers to see the entire medical profile of a patient.
It’s clear that the effectiveness of the payer-provider partnership depends on the commitment of the technology team to follow a logical, structural approach as well as business initiatives to ensure optimal data use is provided.
If you’re wondering how clinically actionable data will impact your medical facility, contact Fast Chart today. We’ll answer any questions you may have and inform you of how our services can help your practice grow.