While health and wellness are critical objectives for every person and population, achieving them is most urgent for Medicaid patients and plan members. To ensure the wellbeing and longevity of all communities, health care organizations, technologies and systems must be able to communicate, share information and work together effectively. This blog post will explain why interoperability is key to addressing population health—and what your health plan can do to ensure it is advanced.
Disconnectedness in population health initiatives
As health plans work toward humanizing the care system and improving overall health and wellness in their member communities, they often face challenges with fragmented strategies, communications and data sources. These hurdles include:
- Accountability for equity: Payers and providers must hold each other accountable for offering and delivering affordable, high-quality services. Rather than looking at it as a stand-off, health plans and care providers each should work together to analyze data, maximize reimbursement, and improve patient outcomes.
- Data organization and application: There is data everywhere, but are you using it well? Payers with well-defined, organized data sets and a robust analytics engine will be better equipped to identify gaps in care and take appropriate action.
- Venues for care accessibility: The most innovative MCOs are taking action to expand access to care and general connectivity for patients. Success requires a multifaceted approach that considers clinician incentives, telemedicine, technological benefits, home health equipment, wearables, etc.
Interoperability and the quadruple aim
Solving these connectedness challenges and advancing interoperability are linchpins to humanizing health care and accomplishing the quadruple aim of lower costs, better outcomes, improved clinician experience and improved patient experience. With better integration, communication and data application, health plans can improve population health and augment value-based care by providing care around the person. This means the right care at the right time in the right setting.
This person-centered, holistic approach to health requires payers to understand the individuals who make up the communities, including underlying causes of ill health, the environmental and structural factors that contribute to care-seeking behaviors (or lack thereof), the massive importance of mental and behavioral health, and more.
Combining this knowledge with detailed data insights around population composition—county of residence, race and ethnicity, education level, socioeconomic status, etc.—will equip payers to understand their communities better, work more seamlessly with clinicians and care organizations, and get closer to achieving health equity and access to whole-person support for their members.
Making the vision a reality
Addressing disconnectedness, progressing toward full interoperability, and achieving the quadruple aim are excellent, imperative goals. So, what can payers do to start making the vision of this better health care ecosystem into a reality?
- Integrate data from nonstandard claims, standard claims, EHR data, surveys, economic trends, census results, and other reliable sources. Though many of these inputs are not strictly care data, they all have a significant impact on how well care is provided and received.
- Be transparent with prices, actions and outcomes to drive accountability. If the community can see who you’re collaborating with, what you’re accomplishing and how you’re performing, both internal and external stakeholders will be empowered to make better decisions.
- Extract and analyze information about population health—vulnerability indices, public transit utilization, education rates, ADA building compliance, languages spoken, etc.—to inform meaningful outreach strategies.
- Execute plans and reflect on success to ensure that tactics are working, communication is strong and goals are being achieved. Adapt your approach where necessary and continue evolving to meet the everchanging needs of our society.
You don’t have to go it alone
Especially in vulnerable populations, there are numerous influencers that must be considered and addressed to enhance health and build better lives. Successfully improving population health is dependent on health plans considering the needs, wants and desires of individuals—and how those characteristics add up to create communities. None of this is possible without powerful, prescriptive data insights. MedeAnalytics has the solutions, meaningful connections, and industry expertise you need to step into the future of interoperability and help your populations flourish. Using analytics to humanize healthcare for those less fortunate is a core belief of our company.
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