Making Clinical Data Actionable with the Right Tools and Strategies

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.