Using clinical analytics to lower clinical costs emerged as the top drivers for payers for using and analyzing clinical data, according to an HIMSS Analytics whitepaper.
Using clinical analytics to lower costs emerged as the top driver for payers, according to an HIMSS Analytics whitepaper.
The research is the second annual study conducted by HIMSS Analytics and sponsored by Anvita Health. It was created from a series of focus groups and one-on-one interviews with chief medical officers and chief medical information officers .
Like in the 2010 study, respondents reported that they currently use clinical data analytics to enhance patient-care cost, safety and efficiency. However, increasingly, the view of quality is being framed within the context of meaningful use. This is leading healthcare organizations to evaluate how they are capturing and analyzing data.
The need for more actionable information is centered around analysis of individual patients and patient populations to identify trends.
“Payers have grown accustomed to, and skilled at, using their data tactically to answer simple questions, like which of their covered patients with diabetes aren’t keeping follow-up appointments with specialists. But many payers still haven’t mastered the practice of looking at their data strategically and putting in place processes to enable broad access to that data, and to integrate and leverage it for enterprise-level benefit,” says says Anvita Health's co-founder and Chief Medical Officer, Ahmed Ghouri, MD. “When they do that, they’ll be able to answer more complex, nuanced questions, such as which of their patients are at highest risk for diabetic complications due to non-adherence and which of their providers scores the best for preventing hospitalizations.”
Preventing encounters with healthcare providers was another theme that emerged in the study. Payers and providers alike targeted data as a tool to help identify and close gaps in care, and serve as the basis for establishing or honing existing wellness programs.
Study respondents reported sharing data with a variety of organizations. Most respondents also reported sharing information with health information exchanges, and those who were not sharing either were currently exploring the idea, or were not located in states that offer this ability at this time. No respondents reported payer-to-payer data sharing, citing HIPAA restrictions as a barrier.
Respondents reported that data warehouses are still not used universally, but payers were much more likely than providers to use data warehouses to store member data. Accessing the stored data presented a challenge, as most organizations do not permit clinicians to directly run queries to the data warehouse. Retrospective reporting dominates the use of data, but there is a desire to use the data in real time to drive clinical decision support.
Respondents had varied answers when asked about the barriers to using data, but common themes emerged:
Getting data into the system.
Data mapping once data is in the system so that it could be extracted for analytics.
Incomplete data.
Multiple databases.
Translating the data into actionable intelligence.
FDA Approves First At-Home Cervical Cancer Screening Device
May 15th 2025Self-collected samples to test for cervical cancer are a step in the right direction when it comes to addressing healthcare barriers, according to Rahma S. Mkuu, Ph.D., M.P.H., assistant professor in the Department of Health Outcomes & Biomedical Informatics at the University of Florida College of Medicine.
Read More
Conversations With Perry and Friends: Paul Fronstin, Ph.D.
May 9th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. In this episode, his guest is Paul Fronstin, Ph.D., director of health benefits research at the Employee Benefit Research Institute.
Listen
Conversations With Perry and Friends
April 14th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. His guest this episode is John Baackes, the former CEO of L.A. Care Health Plan.
Listen
The First Financial Toxicity Tumor Board Reports Success in Individual Patient Savings
May 14th 2025Financial toxicity can affect patient outcomes and quality of life. For example, a patient may forgo treatment or medications to save money, or they may incur high medical debt or go into bankruptcy to pay for medical care.
Read More