by Karen Matthias, MBA, Chief Sales & Marketing Officer
One of the more interesting sessions at America’s Health Insurance Plan’s (AHIP) preconference forum was Data Analytics in a Social- and Consumer-Centered World. The explosion of mobile, social, and cloud-based IT systems in the healthcare marketplace means that stakeholders have access to data derived from multiple sources. Given the increased volume of data that’s now available, one of the pivotal questions posed and examined was “What are the best practices in data analytics and how can health plans use data as a differentiator in their engagement strategy?”
Speakers Joseph Miller (Director, eHealth & Innovation at AmeriHealth Caritas) and Michael Sabin (Director, Enterprise Architecture at Medica Health Plans) discussed how ease of access to healthcare data via electronic medical records (EMRs) was a byproduct of the shift from volume- to value-based purchasing, which requires payers to evaluate outcomes and costs. Payers are becoming increasingly interested in data from accountable care organizations (ACOs). Health plans want to know what motivates consumers to choose a particular health plan over another option. Payers also want to understand members’ health habits.
Data collection, however, is not enough. Patient consent and security of the data need to be addressed. Likewise, with data available from so many sources—EMR systems, health information exchanges, and health aggregators—interoperability of data systems between payers and providers is critical if health plans are to be able to gain insights from the data. Effective analysis and management of data involves translating data into information that drives strategy, which, when implemented, leads to best practices and, ideally, improved patient outcomes. For example, health plans can use EMR data to proactively keep members engaged and on track. Consider a patient discharged from the emergency department, with instructions to schedule a follow-up appointment with the primary care physician. By accessing discharge, admission, and transfer data in the EMR, health plan coordinators can see whether the patient followed through with the instructions and, if not, e-mail a reminder or follow-up with a telephone call. Being proactive and using data in a way that facilitates better treatment supports the mission to improve outcomes and ultimately can set one plan apart from another in terms of service and results.