Last week we sponsored a webinar with FierceHealthcare on how payers can arm providers with actionable clinical data. The webinar offered insights from various stakeholders within the healthcare continuum: Jennifer Shepard, Director UPMC Health Plan Shared Savings Program, Christine Gilroy, Medical Director of Bright Health and our very own Dan West, Associate Vice President of Product Marketing. With 96 percent of providers implementing certified EHRs and the growing importance of data exchange, payers and providers need to learn how to work closely with clinical data to ensure lower costs and improve patient outcomes.
The webinar kicked off with insights offered by Jennifer Shepard from UPMC Health Plan who shared how they are engaging in a shared savings model with 23 primary care physician groups ranging from single practitioners to multi-provider entities. Their goal is to drive down costs and increase quality by giving their provider groups access to financial, clinical and quality data. UPMC has been able to map back towards their goal, specifically working to address Medicaid HEDIS gap closure rates and reduce readmission rates.
The second part of the webinar gave a provider perspective. Christine Gilroy at Bright Health said they use claims based data along with payer data to address physician needs around population health, along with identifying gaps in costs. One example is pharmacy claims for filled prescriptions to reduce time spent in medication reconciliation.
And, lastly, Dan West shared how having the right tools can enable both providers and payers to take action on the information they have readily available. Payers can put in place a system that providers can easily access and implement into their value-based care strategies. Dan highlighted key areas of payer data for providers, including:
- Patient Search
- Face sheet filled with demographic, risk profile and insurance information
- Patient summary with data for managing patient care, such as medications and labs
- Gaps in care that directly impact HEDIS measures and allows physicians to identify areas of improvement
- HCC coding accuracy improvement to identify opened, resolved and unresolved items to ensure reimbursement
- Healthcare services provided
- Full history of providers encountered
- Full prescription history
To access the full webinar on FierceHealthcare – click here. To learn how MedeAnalytics can help both payer and providers gain transparency with clinical data, check out our population health solution here.
Get our take on industry trends
More Megatrends: Price Transparency, Telehealth, Individualized Medicine
By Scott Hampel, president of MedeAnalytics Now that we’ve dealt with Megatrends one through three, we’re approaching the next set.…
Read on...2020 Megatrends: Consumerism, Data Privacy and Security, AI
With 2020 two weeks old, it’s becoming clear the data produced in the healthcare industry by providers, consumers and payers will power and propel our 9 megatrends. Healthcare data is the foundation on which we’re building everything from healthcare outreach for the underserved to new Internet of Things-based healthcare programs to treatments designed just for you.
Read on...Why Unconventional Businesses Will Find Success in Healthcare: It’s the Data
It seems everyone is moving into healthcare. It’s a rapidly growing industry, historically dominated by large, well-embedded companies and organizations, and “pure tech” companies have had difficulty breaking in. That, however, is changing.
Read on...Data and Social Determinants of Health
By Scott Hampel – I think a lot–and I’m not the only one–about how we can improve the ways we pull information from data. Data on its own is inert: just waiting to be understood and then used. And that’s a major challenge for many organizations. Data is often trapped in different applications with no easy or convenient way to extract it.
Read on...