Eliminating information errors is key to Member/Patient Experience in healthcare today.
One of the three aims of population health management is the patient/member experience. In our new world of value based purchasing not only is the experience key but patient engagement is paramount in all aspects of their healthcare to drive better outcomes and lower costs. Many studies have confirmed this point, including a recent health policy brief by Health Affairs that found, “Patients with the lowest activation scores – having the least skills and confidence to actively engage in their own healthcare – incurred costs up to 21% higher than patients with the highest activation scores.” Cost sharing on the part of the payer and provider brings risk into the equation, along with the current fee-for-service model, which has created an environment where healthcare providers are inadvertently concentrating on quantity rather than quality of care. This is one of the reasons why health care premiums have increased dramatically, year over year, growing faster than wages and inflation. For example, from 1999 to 2009, health insurance premiums grew 131%, or 13.1% per year, and this trend is continuing in 2015 with some state silver and bronze plans increasing by double-digit percentages. While the new value based purchasing models are here to stay, there are new policies on the horizon such as CMS driving toward a goal to of tying 90 of traditional, or fee for service, Medicare payments to quality or value alternative payment models by 2018. The premise is that better outcomes lead to lower costs. In this spirit, it is becoming more important to turn patient data into valuable population health information to enable healthcare organizations to answer critical questions with regard to ways to improve patient care and lower costs.
The challenge is that healthcare organizations have data in multiple disparate systems creating data silos that don’t share a single source of truth. Insights into population health management requires these silos to be broken down and data quality issues to be reconciled. The unfortunate fact is that 60% of IT leaders say their organizations lack accountability for data quality. Accountable Care Organizations (ACO’s) and patient- centered medical homes are healthcare delivery models that not only rely upon data interoperability but depend on data quality. I recently spoke to a business intelligence IT leader who works for a large healthcare organization who stated that within his organization there are 133 Electronic Medical Record (EMR) systems, most of which have proprietary codes to collect and store patient data. Also, in the mix on the payer side are extensive systems to handle claims and billing that are rarely tied to the patient clinical data. I believe that the road to better patient/member experience and improved outcomes at lower costs is a comprehensive data governance strategy, which continuously monitors that quality and integrity of internal and external data feeds.
In browsing the consumer affairs website looking for un-happy healthcare customers, I was able to quantify the number of complaints for just one large health plan. The vast majority of the issues had to do with claims denial based on inaccurate membership data and provider data. Health plans today are faced with many challenges around value based purchasing, one of the largest is that healthcare is becoming a mobile consumer driven industry, where members/patients will have greater access to health information patient portals via a mobile device. This trend is empowering patients to get engaged and take control of their healthcare and as a result the patients will have the ability to shop and compare plans. Preventing data quality issues and improving the patient/member experience will be one of the key factors that will separate the health plan winners and losers in the future – the winners will be the ones with the solid data integrity strategy.