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The Affordable Care Act has ushered in a new era of convergence among healthcare payers and providers.
For many, the Affordable Care Act marks the beginning of a new era of convergence in the healthcare industry. For both payers and providers, millions of newly insured lives and the shift toward value-based care have created new pressures. As the interests of payers and providers begin to align, there is a greater interest than ever before to keep healthcare quality high and costs down.
Data plays a key role in accomplishing this goal: with the advent of more care coordination programs, it’s become clear that claims data must be combined with clinical data in order to improve care coordination and drive new payment models. In order for payers and providers to jointly leverage claims and clinical data, their IT systems need to be aligned. Healthcare data is likely to grow exponentially over the next eight years, requiring new types of databases. Once IT systems are aligned and capable of handling various types and large quantities of data, effective population health management is possible.
Because payers can’t control (and often can’t access) the IT systems that providers and patients use (such as EHRs and patient portals) it’s hard for them to gather all the clinical data they need or collaborate with providers in an effective way. We have identified four emerging best practices and the technologies needed to enable them that can be leveraged by both payers and providers to enable effective and efficient population health management:
As partnerships strengthen between health insurers, providers, and members, it is important that value-based payment initiatives align with strategic initiatives, demonstrate value, and manage care toward a state of wellness. It’s a challenging operation, but one that can be achieved with an IT foundation designed to benefit all. As we lay the foundation today for the converged marketplace of tomorrow, getting payer and provider data on the same page is one of the first and most crucial steps.
Suzanne Cogan is vice president of sales and client relationships, Orion Health USA.