Combining Payer and Provider Data to Solve the Blind Spots
STEVE RUBIN Population Health Analytics Consultant, Hennepin Health
While there are some organizations that are much better than others at getting value from data, as an industry, healthcare has a long way to go before reaching the point of diminishing returns from investment in data and analytics. The combination of payer and provider data solves the blind spots of the data sets in isolation. For payers, they are missing the clinically rich information available in Electronic Health Records (EHRs), such as lab results, orders, clinical notes, and vital signs. For providers, they are missing much of the information about healthcare received outside of their systems. Health
Information Exchanges can help solve some of those gaps, but universal participation is not the norm. A model derived from a blend of claims and clinical data would likely be more accurate in identifying risk than a model that uses less complete data. Some have already started evolving toward that with enhanced clinical codes flowing through claims and EHRs that can ingest outside data to get a complete view of patients' risk drivers.
The combination of payer and provider data solves the blind spots of the data sets in isolation … a blend of claims and clinical data would likely be more accurate in identifying risk than a model that uses less complete data."
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Steve Rubin is an analytics expert with more than a decade of healthcare experience. Hennepin Healthcare is a Minnesota-based healthcare system of care with the mission to ensure access to outstanding care for everyone.
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