Mississippi Division of Medicaid Remains the First to Establish Clinical Data Exchange
Each year, state Medicaid leaders from all over the country gather at the Medicaid Enterprise Systems Conference (MESC) to talk about the role of technology in meeting Medicaid and industry initiatives, like value-based care. Our client, Mississippi Division of Medicaid (DOM), spoke on their use of the consolidated clinical document architecture (C-CDA) standard to coordinate care and improve outcomes for their Medicaid beneficiaries. DOM is the first Medicaid agency in the nation to establish clinical data exchange with healthcare providers to directly benefit patients and physicians at the point of care. DOM has successfully exchanged data with University of Mississippi Medical Center (UMMC) which resulted in more than two million clinical summaries. They also recently partnered with Hattiesburg Clinic and shared more than 100,000 clinical summaries.
To achieve this level of connectivity, DOM faced many challenges such as differences in vendor implementation of industry standards and providers’ use of unexpected medical codes. We connected with Ian Morris, Project Manager for the State of Mississippi DOM, to get his take on the overall lessons learned from this project and what fellow government organizations need to keep in mind for similar undertakings. Here are three key takeaways:
- Rely on Vendors’ Expertise – DOM would not be able to achieve this level of success without qualified vendors who have the expertise to develop and support the technology infrastructure and needs of real-time data exchange for hundreds of thousands of beneficiaries.
- Be Realistic – These projects are time and labor intensive and can take years to achieve. Be patient and work around your trading partner’s various schedules and technologies.
- Collaborate – Every stakeholder has different end-goals but these projects are a joint effort. This means that the conversation needs to move away from “my data” and towards “our data” to better coordinate care.
Looking ahead, DOM plans to continue integration with Medicaid-focused health systems, Health Information Exchanges and state and federal agencies. In fact, just last month they went live with their third clinical data exchange connection – Singing River Health System.
To learn more on UMMC and DOM’s success, read our announcement here.
CHIME Series: Are you making the most out of payer data?
This week, we continue to explore the results of our College of Healthcare Information Management Executives (CHIME) survey and the need for various data sources. Our survey asked the question: Do you have a strong grasp on how to deal with payer data today? The results show that the majority (57 percent) of provider organizations do not.
As healthcare costs continue to rise and the industry focuses on value-based care, payers and providers need to look for ways to collaborate. This relationship is critical to payers as they leverage EHR data to better understand the cost of services rendered by the providers, measured against the outcome of care. For providers, combining both claims and clinical data can reveal some extremely valuable insights that can positively influence clinical decisions and drive down costs. However, many organizations still face challenges, including a lack of appropriate tools and an influx of data that is difficult to manage. This then creates a lag in insights being delivered to the right people at the right time. Bruce Carver, associate vice president of payer services, believes optimized organizational coordination can help address some of these issues.
Here are two of his best practices for making the most out of payer-provider collaboration:
- Trust Each Other– The first step in any relationship is trust. Are your goals aligned? Do you have redundant reporting or processes to get to these shared goals? Where can things be streamlined? This relationship will take time as both parties must work together to improve collaboration and ultimately gain more insights.
- Establish Communication Processes – Communication is also key and establishing efficient processes can help ensure that organizations are on the same page when issues arise. Some of these issues include, gaps in payer data or instances when payer data is not directly aligned with provider data.
Once organizations are aligned, payer data can be leveraged to better meet industry-wide demands of becoming more patient-centric and value-driven. This collaboration can also help providers manage medication adherence and establish cohesive strategies that address this issue.
As providers continue to struggle with a lack of organizational resources and payers begin to shrink in numbers, payer and provider collaboration will be more important than ever. Additionally, creating this collaboration can help both parties ensure that they are on the right track towards value. To see more results from our CHIME survey, access recent blogs here and here. If we can help get your organization on the right track, make sure to contact us.
CHIME Series: Creating Value Out Of Your Analytics Investment
We are continuing to focus on the insights from our College of Healthcare Information Management Executives (CHIME) survey. This week we’re exploring the response to one of the questions asked: Do you feel that you have realized the full ROI of your data warehouse and analytics investment? The results to this survey question were astounding with close to 100 percent (95.7 percent) of respondents stating they have not realized the full potential of their investments.
In this blog post, we outline the necessary steps to take to ensure a return on your analytics investment. With nearly every healthcare organization somewhere along the value journey, it’s important to keep in mind that each step should be tailored to meet specific business objectives. Here are three guidelines to start:
- Offer Self-Service Access to Business Users: Although an investment has been made many organizations struggle to fully adopt the platform due to IT bottlenecks in reporting and analysis. By empowering business users with the ability to perform their own analysis to identify the root cause of trends, the speed from insight to action will increase.
- Find New Value in Existing Claims and Billing Data: Most data warehouses focus on aggregating clinical data from EMRs, but many healthcare organizations fail to recognize the potential in claims and billing data. Most data models are built on this type of data, so their value should not be underestimated.
- Achieve Quick Wins: Starting small is key. Sifting through and analyzing data can be a large and daunting task, so it’s important to remain focused at the start of your project and then expand. Focus on one or two small use cases such as medication adherence or hospital readmissions. Once those initiatives are deployed, set realistic metrics and timeframes to properly measure progress. If progress is being made, make sure to continue driving the initiative and look for additional growth opportunities.
With these best practices, healthcare organizations can begin to realize the value of their analytics implementation. To learn more, download our white paper here. If you’d like to partner with us – go to: medeanalytics.com/company/contact.
CHIME Series: Are You Making the Most of Your Analytics Investment?
This week we are continuing to share our College of Healthcare Information Management Executives (CHIME) survey results with you. The focus is specifically around the question: Do you feel that you have realized the full ROI of your data warehouse and analytics investments? The results were telling – with close to 100 percent responding “no.” The healthcare industry continues to view data and analytics as top priorities to driving change. We have outlined best practices and strategies to ensure healthcare organizations receive the full potential of their IT investments while making strides to maximize value through the improvement of quality care and reduction in costs.
In partnering with our clients, MedeAnalytics works to ensure that the large hospital investment – both from a cost and organizational perspective – is realized. The key to achieving an overall best-practice strategy is to not only take data to insight but also into action. Below are five steps healthcare organizations can do to get their analytics investment on track:
- Identify enterprise champions – They will be the point-people to turn data into change as they will lead the entire organization’s attitude on data governance. Establishing authority will create a trickledown effect ensuring value is tracked and achieved.
- Find value in existing data – Organizations should leverage their core data set and claims data, but also pull in existing ancillary data to have a better understanding of their organization.
- Create a data-driven culture – An analytics department ensures that the entire business is standardizing and handling data consistently, but also encourages the new analytics department to champion a holistic approach towards data management.
- Outline and develop manageable goals – Instead of tackling all problems at once, start small. By setting a goal with real, manageable next steps, the organization can quickly perceive value in an enterprise initiative.
- Train, train, train – Repeated trainings and regular communications ensure long-term success. By holding teams accountable, while empowering them with resources to succeed, data sharing efforts across the enterprise are bound to improve.
An investment in analytics is the first step toward becoming a data-driven healthcare organization; however, the real change comes from leadership and education. To learn more about analytics best practices, download our whitepaper here. For success stories, access our case studies here. If you’re looking for guidance on how to make the most of your analytics investment – make sure to contact us: http://medeanalytics.com/company/contact
CHIME Series: Are Self-Insured Providers the Future of Healthcare?
As healthcare’s future continues to be battled on The Hill, we recently conducted a College of Healthcare Information Management Executives (CHIME) survey that outlined several questions around the various data-challenges facing healthcare organizations in the transition to value. This week’s blog focuses on the survey question: With the shift to value-based care, has your health system considered becoming or adopting parts of an integrated healthcare system (i.e., becoming a provider and a payer)? The results show that more than half (61.7 percent) of respondents have considered moving towards this model. As the U.S. healthcare spend continues to rise, with average healthcare costs close to $10,000 and the national level equaling more than 3 trillion, the need to better manage expenses is a top priority. One way to do this is through the cohesion of payers and providers, along with the use of data analytics as a guiding light.
At MedeAnalytics, we’ve worked with two healthcare organizations who have created an integrated healthcare system and utilized their valuable data resources to create analytics platforms that break down barriers and lead to lower costs and higher quality care.
Covenant Health: Covenant Health (Covenant), a self-insured hospital, uses data analytics to adopt an innovative approach to population health to drive down costs and engage in preventative care initiatives. Using a data analytics approach they achieved the following:
- Identified healthcare utilization to improve care for employees and their families
- Designed benefit plans
- Reduced overall health spend
By drawing insights from population health data, they strategically identified at-risk patients and proactively managed their care. Covenant determined that employee healthcare costs were more than 10 percent higher than the general population. Overall, just 9 percent of the highest risk employees were found to be responsible for 40 percent of employee health plan costs. The insights found in the data enabled them to proactively manage their employee population to identify exactly where money was being spent.
Presbyterian Healthcare Services: Presbyterian Healthcare Services (PHS), is an integrated healthcare provider and payer organization, looking to improve quality and reduce costs. Using data analytics, they strategically differentiated themselves and have added value within their integrated model. To achieve their success, PHS focused on three distinct categories:
- Created Value for Key Stakeholders
- Integrated Payer and Provider Analytics
- Promoted a Data-Driven Culture
PHS achieved ROI in its clinical, operational and financial areas within their enterprise. Additionally, PHS recognized operational efficiencies by replacing seven analytics vendors with MedeAnalytics, reducing redundancies and achieving quick wins with business stakeholders. More so, PHS expects to save millions in 2017 by improving collection for Medicaid encounters and increasing business development revenue.
To learn more about Covenant’s success, check out their case study here. For insights on PHS’ journey with data analytics, click here. If you’re looking for ways to become an integrated system or want to learn more, reach out to us: http://medeanalytics.com/company/contact.