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.

Check out InterSystems new Managed Care Organization (MCO) eBook which provides insights on clinical data use and adoption based on a recent survey.

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.

Doctor working on a tablet.

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

Upcoming Webinars:

FAHP Webinar:  COVID-19 as an Interoperability Catalyst
August 4, 2020, 10:00 a.m. – 11:00 a.m. EDT

Why Payers Need an Interoperability Strategy: IDC’s Eight Reasons to Do It Now
August 18, 2020, 1:00 p.m. – 2:00 p.m. EDT

FAHP Webinar: Maintaining Provider Information Shouldn’t Be Hard
September 22, 2020, 10:00 a.m. – 11:00 a.m. EDT

On-Demand Webinars:

Da Vinci Community Roundtable: What It Takes – How To Leverage The HL7 Da Vinci Project To Drive Quality Measurements and Value-based Care

Strategies for Implementing the ONC and CMS Rules

Demystifying the CMS Interoperability Rule – What Do Payers Need To Do

REAL Clinical Data to Improve Health Plan Performance

Da Vinci Overview With a Focus on Quality Measures

Want better Quality and Risk scores? Clean clinical data can get you there

AHIP – June 16-18, 2020 Miami, FL

NG Healthcare Summit – June 22-24, 2020 Arizona

RISE – June 28-30, 2020 Music City Center in Nashville

HFMA – June 28- July 1, 2020, San Antonio, TX

HFMA Though Leadership Summit – October 1-2, 2020 Washington DC.

HLTH 2020 – October 11-14, 2020, Las Vegas NV

Gartner IT Symposium/Xpo – October 18-22, 2020, Orlando FL

CHIME Fall CIO Forum – November 1-2, 2020, San Antonio TX


Industry Participation

HL7 FHIR Da Vinci

InterSystems is a Member of the HL7 DaVinci Project at the “Sponsorship Level”

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