How to balance high-quality care with rising costs

Healthcare organizations across the United States face the challenge of providing consistent, efficient care, especially for patients outside their clinics. Shortages in the workforce hinder their capacity to ensure patients complete regular lab work and screenings. Healthcare leaders express concerns that inaccurate data isn’t helping efficiency either, describing scenarios where care coordinators waste time attempting to schedule screenings with patients who’ve recently had them which is frustrating on both sides.

In a recent webinar, Arcadia’s Josh Cabana, Director of Enterprise Partnerships, Candace Perry, Manager of Training and Enablement, and Christine Knox, Solution Engineer, demonstrated how important it is for healthcare organizations to have technology that delivers access to timely, accurate data and uses that data to streamline processes and improve quality performance.

Generating reliable data

Before an organization can use data to improve quality performance, it must establish standard data practices for inputting the data. Clinical data is incredibly useful for quality improvement as it can supplement and provide context for claims data. Combining the two forms of data clearly defines the next actionable step for care management teams. Primarily, the healthcare organization must decide what clinical data to enter in the EMR and the format to enter it in.

“A1C is a great example. I've seen it come through as A1C, hemoglobin A1C, HBA1C, and every other variation under the sun that you can think of that all mean the same thing,” said Cabana. “Make sure to consider those terms are considered and flow into the measures like they should — which is why having a governance process in place is incredibly important.”

Arcadia’s Console Term Mapper helps organizations account for those clinical nuances and trust their foundational data by identifying unmapped clinical terms and ensuring they are correctly mapped to quality measures.

Defining core quality measures

Management of quality can be a nightmare for providers who see a range of patients who have different types of coverage. They need to spend their energy using their clinical judgment rather than piecing together a puzzle of unique criteria for each payer.

Healthcare organizations can take this burden off of the providers by defining a set of core operational quality measures to hold them accountable. This tactic not only alleviates day-to-day stress for the provider but provides transparency for the payers and helps during contract negotiations. Perry notes that it’s important to clearly communicate the operational set of measures to front-line staff, which allows providers to see exactly how they perform against the measures.

“For the medical assistants, the front desk, or the practice manager at the physician's office to understand how important these measures are, we take what's in the system and display it in a functional way that makes sense to that group,” she explained. “This is going to help from a population health perspective as well as achieve those contractual benchmarks with payers.”

Arcadia’s Vista dashboards, a built-in business intelligence tool, lets organizations see those quality insights, both at the delivery system or payer level and drilled down to the provider level and the member level.

Maintaining payer contracts

There's no way around submitting supplemental data to payers, but the process can be burdensome. With the right tools, it is possible to streamline sending this type of data in a structured way. This enables organizations to avoid breaching contracts and ensure compliance.

Improving patient satisfaction with data

Timely and accurate data reduces friction between patients and providers by reducing the number of unnecessary, often frustrating interactions. It also has the potential to strengthen patient relationships by bringing additional information such as social determinants of health data to the forefront.

“When a care coordinator calls to schedule an annual wellness visit, they also ask how things are going at home, and they already have an idea from social determinants data that there might be food insecurity or other challenges. So, they can ask those questions, connect them with community resources if it's appropriate, and try to squeeze as much out of those patient touch points as they can,” said Cabana. “And when you do that with trusted, accurate data, these interactions drive up the satisfaction and the quality of the relationship.”

Putting evidence behind quality measures

It’s easy to get bogged down in payer requirements, but at the end of the day, quality measures have clinical evidence behind them that says they can potentially save the lives of patients. The technology tools that manage quality and generate insights for providers help make patients’ lives better.

Watch the full webinar to learn more about leveraging data to create a more efficient, safer, and cost-effective healthcare ecosystem. For details and a demo of Arcadia’s healthcare data analytics capabilities, reach out to us.