As Opportunity Knocks, Will you Listen?

They say that less is more, but sometimes more is in fact more. With the existing and emerging technology found in today's healthcare environment, healthcare organizations are able to collect, interpret and react to more data about patients and their care than they ever have before. This ability to access and leverage large volumes of data is shifting healthcare from a predominantly reactive endeavor to a more proactive one, and supporting more targeted interventions that improve the quality of patient care as well as its efficiency. In this context, more data means more tangible benefits for healthcare providers, payers and patients in terms of better patient outcomes.

Health Reform is Spurring Data Use

The Affordable Care Act (ACA), Meaningful Use (MU) and other healthcare reform initiatives are driving the industry toward more interactive data use. Health plans, for example, must collect large volumes of data, including risk scores, prior admissions, number of medications, number of chronic conditions and frailty indicators, to support compliance with federal requirements and ensure the accuracy of risk profiles.

A valuable byproduct of all this mandatory data collection is the ability of a health plan to not only see what care its members receive but what care they should receive but do not. For example, if a Medicare Advantage member has multiple visits to several different cardiologists but no diagnosis for hypertension or other cardiac issues, there is a potential gap between the care the patient needs versus the care he or she is receiving. These gaps present opportunities to improve care and thus transform patient health.

Taking this information one step further, health plans can begin to close identified care gaps. By visiting targeted patients in their home or reaching out to them through the telephone and conducting assessments, health plans can create a holistic picture of a patient, identifying the various doctors the patient has seen in the past year, the number of medications the patient is taking, the nature of the patient's medical condition and so on. This patient portrait is quite valuable because it shows a comprehensive picture of the patient that a single healthcare provider cannot often obtain.

Fostering an Unlikely Partnership

Now imagine if a health plan partnered with a group of healthcare providers and connected patients with known care gaps with providers who could close those gaps. In these cases, the health plan could share information from the patient profile with everyone involved in the patient's care. Providers could use this information to get patients into care and target the care they provide, ensuring both quality and efficiency.