Payers could do better job of leveraging data

April 15, 2011

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.