The move toward fee-for-value reimbursement models, an increased focus on consumer choice, and the introduction of new technologies continue to drive radical change across healthcare. But as the industry advances, new challenges present themselves. One challenge for providers is to ‘turn data into action.’ Smart healthcare organizations understand that the right information can guide decision-making that improves quality and maximizes reimbursements under new value-based payment structures. But how can healthcare organizations identify and harness the “right” data?

With 10+ years of expertise in data aggregation and analytics technology, this is Arcadia’s sweet spot.  We help healthcare organizations get the right data by focusing on three things: aggregating data from across a health system and health plans, integrating claims and clinical data for a complete view of the patient, and ensuring appropriate data governance to maintain the quality and usefulness of the data over time.

Moving to a single data repository doesn’t mean moving to a single EHR

Most hospitals and healthcare organizations today are compiling lots of data related to patients – both individually and as a population. However, many systems have more than one EHR or disease registry, each speaking its own language and accessed differently by almost every department. This lack of a seamless, integrated information exchange within individual healthcare systems is a huge problem. A single patient may have data that is housed across several locations, and an individual provider won’t have access to or knowledge of the majority of it. Physicians are stuck making decisions without a full picture of their patient or patient population’s health.

Healthcare organizations need a single data repository to support population health management, but ripping out and replacing EHRs can be a costly approach, with major impacts to provider productivity.   And at the end of the day, an EHR alone may not deliver the high quality data asset that is truly required for population health analytics.

Fortunately, there’s an alternative that can both simplify the exchange of information and improve care quality, and drive and optimize business performance.  By integrating data from many EHRs and other sources into a single, centralized data repository designed for population health analytics, solutions such as Arcadia’s allow healthcare providers to easily and efficiently identify patients who need services using trusted, high quality information.

Collaboration is key to getting a complete view of the patient

In order to effectively manage a patient’s care, a provider needs a complete picture of the services the patient is receiving – both at the provider’s own office and outside the network.  Claims history can be crucial to filling in the gaps, but often the lack of collaboration between providers and insurers is a barrier to data sharing.  Similarly, health plans possess hoards of administrative data, like members’ basic demographic information, as well as a history of past diagnoses and procedures, but what they don’t have is easy access to clinical data from the provider side.  This means that they miss the opportunities to identify high-risk or rising-risk patients.

When these two stakeholders join forces and collaborate on sharing both parts of the puzzle, providers are much better equipped to make real-time decisions and better manage patients’ health based on a more complete picture of their health history.   And plans are able to better understand the actual risk of a managed care population and support providers accordingly.

However, fostering this collaboration requires that both sides trust each other and the data being shared.  Technologies that facilitate this type of exchange need to ensure that the data is accurate, timely and complete.  Relying on a neutral third party like Arcadia for developing a high-quality data asset that integrates claims and clinical data helps to nurture the payer-provider relationship while still allowing both parties to operate as separate entities.

Data governance ensures data are useful over time

Lastly, as the healthcare industry looks to unlock data in its mission to focus on value, provider executives must establish governance policies over the data – they are the stewards of a critical asset for their organization. There must be a single executive – the Data Steward – whose primary role is to manage the quality and quantity of the organization’s data asset, ensuring that data is appropriate, accurate, and actionable. The teams that manage and use the data must have clearly defined and enforceable processes that allow it to be leveraged across the organization. Those organizations that are identifying and incorporating governance now will be the ones successfully using data to treat populations in the future.

Harnessing data into an actionable, consolidated view of the patient is the future of healthcare. Providers must learn to access and use the data to understand what patients need as they aim to increase value, improve care quality, lower costs and increase their own reimbursements.

Brian Croegaert, RN BSN is the executive vice president of managed care at Arcadia Healthcare Solutions.

Brian Croegaert, RN BSN

Brian leads the Managed Care line of business for Arcadia. He has 30 years experience developing solutions that improve results across a variety of healthcare delivery systems. His areas of expertise include detailed knowledge of clinical integration, and the application of medical data and information technology to enhance the delivery and outcomes of clinical care.

His holistic understanding of healthcare environments is informed by the front-line experiences he had as an R.N., before becoming an executive. Brian joined Sage Technologies at its founding in 1999, serving as chief operating officer before being named CEO. Additional areas of expertise include complex care management, care protocols, operational efficiency, payer systems and functions, and information technology.

April 7, 2016