More healthcare organizations than ever are embarking on value-based payment programs, such as the Medicare Shared Savings Program and commercial accountable care organization initiatives. These program participants are discovering that efficiently managing populations of patients, especially high-risk patients, is essential to earning enhanced revenue and controlling costs.
Unfortunately, the data analysis used to manage these populations across the care continuum, detect care gaps and initiate interventions is usually based on claims data that could be as old as 120 days. For more timely analysis, many organizations are leveraging their own electronic health record data.
This data, even within integrated organizations, is difficult to aggregate because it is often captured with different documentation methods or is locked away in incompatible EHR systems. Even when patient data is harmonized into a single record, it does not provide critical insights into claims-related data, such as hospital costs, or which patients are receiving care elsewhere, and why.
