How Important is a Clinical Data Strategy?
Real-time access to clinical data can enhance business processes, reduce costs, and improve the experience of care for everyone. Automating prior authorizations alone could save the industry billions of dollars. InterSystems can help.
Improving Care Coordination & Management
Chronically ill patients with highly fragmented care cost almost double that of patients whose care was well coordinated, and were more likely to have preventable hospitalizations.
The Benefits of Real-time, Comprehensive Clinical Data
Giving case and care managers access to clinical data in a unified care record, like that provided by InterSystems HealthShare, allows them to share insights on patients and a care plan for better coordination.
HealthShare’s unified care record, receiving real-time clinical feeds, can send out alerts on inpatient and emergency department admissions to the primary care provider and the payer. The alerts enable better care coordination for the patient, and automatic enrollment through HealthShare into care management programs. The clinical data also can populate Care Management/Utilization Management systems, assuring current and accurate information.
Enhancing Quality & Streamlining Measurement
Improvement happens continuously, not 90 days ago. Clinical data gives you the information and perspective needed to make course corrections. Recognizing this, NCQA recently created a draft specification that expands HEDIS measurement to support clinical data, with 2019 as the first year that they will accept data directly from clinical systems for a limited set of measures.
Real-time clinical data from HealthShare can feed HEDIS and STARS quality measures, allowing for continuous monitoring and improvement.
Optimizing Network Performance
As a health plan, your greatest asset is your provider network. The more they provide cost effective quality care to members, the better it is for everyone. The key is transparency in data sharing: Making it possible for providers to see how they are performing against value based contracts, giving them insight into a longitudinal view of the care record, and helping them to succeed.
Making Operational Processes More Efficient
Which manual payer/provider process cries out for automation? If you said prior authorization you’re not alone. The prior authorization process costs $23 to $31 billion per year in the US, according to a 2009 study published in Health Affairs. The health plan cost per manual prior authorization is $3.68, compared to $0.04 per electronic prior authorization, according to a 2017 Chilmark Research report.
It’s not just the bank account that suffers. Delays in the process affect provider morale and patient care. Combined, physicians and nurses spend about three and 13 hours a week, respectively, dealing with prior authorizations – time better spent with patients.
Reimagining this and other processes to make them more efficient requires access to clinical data. Examples, in addition to prior authorization and utilization management, include compliance with state or federal programs such as lead screening, and eliminating the HEDIS chart chase.
See us at a local event near you!
Payer Industry Events
Medicare Advantage Leadership Innovations – January 28-30, 2019, Phoenix, AZ
HIMSS 2019 – February 12-14, 2019, Orlando FL, Booth #1159
13th Annual RISE Nashville Summit – March 17-19, 2019, Gaylord Opryland Resort, Nashville, TN
Blue Cross Blue Shield 2019 National Summit – April 29 – May 2, 2019, Grapevine, TX
Health Insurers Can Improve Health Care Through a Digital Strategy – May 14, 2019, 12 pm – 1 pm EST, Online AHIP Webinar
AHIP Institute and Expo – June 19-21, 2019, Nashville, TN
HFMA 2019 Annual Conference – June 23-26, 2019, Orlando, FL
National Conferences on Medicare, Medicaid & Duals – September 22-26, 2019, Washington, DC
Note: InterSystems at the conference on September 25-26
HLTH 2019 – October 27-30, 2019, Las Vegas, NV
InterSystems is a Member of the HL7 DaVinci Project at the “Sponsorship Level”