Powering change with health intelligence
In February 2011, the U.S. Department of Health and Human Services (HHS) launched a “Health Indicators Warehouse” web portal with the goal of helping Americans understand and improve the health trends of their communities.
The website is easy to navigate and allows users to mine data by topic, geography (down to the county for some indicators), or by state and federal initiatives.
Want to know how the admission rate for hypertension in Des Moines compares to Houston? Done. Interested in learning the likelihood of obesity in a specific city? You got it. The HHS’ new warehouse provides these facts and figures along with the methodology and a listing of intervention programs available in that region.
By providing this depth of health data for populations throughout the country, HHS hopes to achieve what all of us want: better outcomes for patients. This idea is only possible by providing evidence-based health intelligence to influential groups in a transparent way. Just as HHS intends to do with the Health Indicators Warehouse, observing our nation’s macro health trends facilitates conversations about how the industry can creatively unite to repair and improve patients’ health; now, and in the future.
To move the needle in quality, attract and retain patients and improve the bottom-line, payers and providers need to learn from the HHS’ use of data and trends. Health intelligence must be at the cornerstone of a collaborative payer/provider relationship. By having an open dialogue - transparency - about the health of patients, payers can compare their population’s health performance to other networks and identify “interventions” that should take place.
Sharing these holistic observations arm healthcare providers with an evidence-based argument for changing services offered, treatment strategies or staffing. Additionally, payers can proactively manage their initiatives to be sure they are making the right investments, at the right time, in their networks.
Smarter and faster business intelligence is one central part of the equation, but it must be used in a way that supports both parties in reducing costs, increasing efficiencies and improving care. The challenge in this is determining how to achieve a closer, more collaborative relationship between payers and providers. Both parties should think beyond the linear lines of their claim/reimbursement relationship.
Historically, payers implemented utilization management and disease management processes to review, approve or deny services ordered by physicians. The protocols and review processes utilized were not shared with the ordering physician. The stated intent from the payers was to optimize the quality and cost of the care being provided to the health plan member.
Generally, providers viewed this as burdensome, inefficient and out of bounds for the payers to be determining the optimal care for their patient. The challenge was caused by the lack of data transparency.
In order for payers and providers to bridge the historical chasm, data transparency will be paramount. One example of this effort can be seen in the development and implementation of care gap messages; a real time delivery mechanism notifying a provider of a patient’s need for preventative care.
Evidence based protocols are used to define the types of services that should be delivered to a patient with a given condition. If that service has not been performed, based on a review of all claims submitted, the physician will be notified via a care gap message. Rather than dictating a service to be provided, the physician is then empowered to act accordingly if the situation warrants action. This slight nuance demonstrates the collaborative sharing of information in a transparent manner.
The public sharing of healthcare data is an exciting new trend with a lot of power to drive change. For payers and providers, access to this kind of intelligence isn’t new. Influential groups, including payers and providers, should take on the same task assigned by the HHS and use their data creatively, in the right ways at the right time to make a difference.
Jim Bohnsack is vice president of TransUnion Healthcare.
