MARSHFIELD, WI – Security Health Plan of Wisconsin relied on traditional methods of member and provider communication for preventive care and Healthcare Effectiveness Data and Information Set, or HEDIS, measures, respectively.
With the implementation of ikaSystems' ikaProHEDIS+, the physician-sponsored HMO can now evaluate clinical outcomes on a timely basis and communicate with members and providers in multiple channels, said Jane Wolf, health services director.
The application "fits very nicely" with its strategic direction of being member centric and delivering quality information for members and providers, she said.
The push for quality of care and supporting data is coming from three areas - the Centers for Medicare and Medicaid Services (CMS), State Medicaid Programs and commercial health plans, which are providing data back to their self-funded groups, said Ravi Ika, president and CEO of ikaSystems.Historically, quality of care data is delivered retrospectively, which impedes a physician's ability to improve his or her scores for HEDIS or pay-for-performance programs because the data is not immediately accessible, said Cynthia Burghard, senior vice president of market intelligence at ikaSystems. Data needs to be delivered in real time because, she said, "you need to use data to manage quality, not just report on quality."
Janice Young, program director for Health Industry Insights, agreed. Retrospective data and reporting have long been complaints of physicians because of the lag time in being able to impact or adjust patient care, she said.
Prospective tools, such as ikaProHEDIS+, however, can provide on-time, cross-sectional analysis of providers that can lead to patient outreach and impact clinical outcomes, she added.
"We're moving information to affect an action, not just to know what took place in the past," Young said. "Prospective tools create an action closer to the time of care so that care can be improved."
Health plans are focusing on systems and operational workflow, and using analytics to deliver, for example, actionable data and alerts to the physicians, Burghard said.
It's taken business intelligence technology some time to get to this point, with communications tools coming along in the last couple of years, Young said.
"It could not be better timed," she added, referring to the economic downturn's pressure on decreasing healthcare costs. "The market reception has been quite good."
