Using Data to Improve Clinical and Financial Outcomes

Las Vegas—With the growing implementation of electronic health records, patient data collection and integration has come to the forefront of healthcare management. During a session at the NAMCP forum, Elizabeth S. Miller, MPHA, president, BPKMiller Associates, discussed opportunities for data integration improvement in order to promote better clinical and financial outcomes.

Ms. Miller began the session by discussing Healthcare Effectiveness Data and Information Set (HEDIS®) rates and how to improve them. In order to improve preventive health screening rates by identification of services received and not reflected in HEDIS rates, providers will need to obtain and abstract medical records for administrative records according to HEDIS specifications, identify areas of opportunity to capture data that are currently being missed, and address the opportunities.

A focused medical record review will confirm services provided, identify any measure-specific exclusions removing the member from the HEDIS report, provide the information required to verify correct coding on billing, completely capture information in claims system, and accurately complete the HEDIS report reflecting the care provided.

Doing so can lead to improved HEDIS rates, improved future claims-based reporting, education of providers in proper coding and billing requirements, compliance by the health plan with state and federal requirements relative to improved preventive health rates, and closer collaboration with physician groups.

“Health plans partnering with physicians and provider groups to outreach to members, rather than only outreach from the health plan, is a part of the future of healthcare quality improvement,” said Ms. Miller.

She detailed an action plan to support provider communication with patients, including:

• Coordinated education program with the primary care provider (PCP) for patients in need of targeted services via a letter signed by the PCP and health plan and a phone call using the voice of the PCP
• Focus on large practices in need of rate improvement that requires support in identifying patients and services
• Provide to PCP member- and measure-specific reports to be used at time of office visit

Through the coordinated provider outreach, a focus on members in need of specific services and utilization of a different approach to member communication that is more effective than mass and impersonal mailings and supports the physician in improving the patient–physician relationship can be achieved, according to Ms. Miller. The results of the programs include improved HEDIS rate compliance for participating physicians and practices; enhanced patient–physician relationships; results in education of the practice and physician in the HEDIS measurement requirements; improved member satisfaction with the health plan and PCP; and compliance of the health plan with any applicable state and federal requirements relative to improvement in preventive health rates.

Ms. Miller also discussed improving population health management through updated member contact information, which can lead to corrected and updated information, an increase in percentage of members
successfully contacted, improved percentage of engaged members to provide care coordination, and improved care coordination and support services for members, which can then improve satisfaction with the health plan.

“The picture of your members, patients, [and] customers is incomplete. [There are] lots of data, but missing links,” said Ms. Miller.—Kerri Fitzgerald