As the healthcare industry continues to move towards value-based payment models, data is playing an even greater role in health plan decision making. Recent studies have shown the clinical information being gathered only tells a fraction of the story and having one single view of healthcare data is critical to driving insights into better patient care and monitoring quality metrics.
According to Michael F. Wilson, Director of Marketing, Industry Software Solutions at Pitney Bowes Software, quality scores are becoming more important as they reflect operational efficiencies between payers and providers. In a recent webinar, Mike discusses new ways of thinking about data management and how healthcare providers can overcome some of the data management challenges that many experience today. Mike says there are three key principles healthcare providers must follow to enable data and get out in front of the results:
• Enrich the profile to see the whole person. The patient profile should include more than basic customer information. It should include additional datasets like lifestyle, environmental, and social determinant data. This information should be available before you ever meet the patient so issues with quality measurement can be prevented. Having access to a larger set of patient data allows you to segment your population by certain determinants as you are analyzing trends.
• Recognize patients through all consumer touch points. It’s important to track patient data through all customer touch points – whether it happens in the contact center, a patient portal, or even through a mail order pharmacy. This can be a challenge considering many databases and IT systems are siloed, yet it’s a critical element for quality improvement because more often than not, a patient’s experience depends on how well you understand them.
• Analyze relationships to understand risk. It’s important to go beyond the data in front of you to better understand the patient’s risk profile. This may mean conducting additional research to understand the patient’s familial structure or relationships between his or her primary care physician and specialists. Having a holistic view of the patient helps you gain insights so you can better manage risk.
Information must then be pulled together across multiple touch points to better understand the patient and level of risk associated with each. Chuck Kane, Managing Director Single View of Customer of Pitney Bowes adds that relationships exist between practitioners, pharmacists and insurance companies, but there is often a “missing link” in analyzing these relationships. He points out the importance of first understanding the IT infrastructure that exists within your organization because data exists all over the place and it must be brought together in order to gain insights.
You may need to implement new data governance processes to better understand nuances like what data needs to be controlled, which data is specific to certain departments and can’t be shared, data that is cross-functional, or data used for business intelligence. Then you can develop what Chuck calls “domain models”, which may include rules what information should be stored on the patient, contact information, location or social determinants. After you have the domain models in place, you can take the data and map it back to a roadmap.
Siloed information usually presents a blurry picture of the patient view but by gathering data from disparate sources you can start to make inferences about relationships and are able to see the bigger picture into areas that impact the patient’s health. A single view of patient data will gain help you gain insights into non-obvious relationships which allows you to better manage risk. From insights you will gain the wisdom needed to have a better understanding of the patient’s journey.
Interested in learning more about ways to manage data quality in a value-based environment? View the webinar here.