Report: Health plans need to streamline data efforts to reap benefits

Health plans now gather and report data for quality reporting, claims reporting and to conduct risk adjustment analysis, but typically these various data collections occur separately, are sometimes duplicative and are uncoordinated, say Deloitte experts. But that will soon all change.

By 2040, health data will benefit from interoperability and will be continually updated, making it easier to discover insights into healthcare and its costs. That’s why health plans should invest in a strategy with an eye toward this future, says Claire Boozer Cruse, a health policy manager with the Deloitte Center for Health Solutions.

“Within the context of value-based care, there is an imperative for health plans and risk-bearing providers to bring historically siloed data sets, processes and people together in ways that are more seamless for operational efficiency,” according to Matt Siegel, specialist leader in the life sciences and healthcare practice at Deloitte. The idea is to help lower the abrasion level for physicians and bring about high-quality healthcare results, he says.

Siegel-Matt-CROP.jpg

Deloitte recently conducted a survey of seven Medicare Advantage (MA) health plans and two vendors that provide analytics solutions to discover how their data is being used. “We use Medicare Advantage as an example, because if anything, it’s a leading indicator, ahead of the market with sole risk capitation, which is the exception to the rule,” Siegel says. “We have a little lab here with Medicare Advantage.”

Most of those surveyed said their organizations would like to integrate and align risk adjustment and quality functions, but they are still mapping out the strategies. They also said it is difficult to integrate care management data with quality and risk adjustment analysis data. Care management functions at most organizations are separate, sitting in the medical management function, and most often report to the chief medical officer, the survey found. Some of the respondents said the ideal future would include integration of care managers with risk and quality functions, harmonizing the data across all functions.

Indeed, the ideal is not yet reality. “None of the organizations have arranged their operating model, data and systems to facilitate seamless handoffs between these functions,” the study found. “Most are working to identify overlap across functions, but different individuals lead improvement and change efforts in each area, and most organizations are still determining how emerging technologies will play into their future analytics strategies.”

Over the next five years, Cruse and Seigel see two types of opportunities for health plans to manage their data better, including coordinating the data and processes with an enterprise-wide strategy. This includes automating aspects of data collection and reporting using tools like robotic process automation, natural language processing, and artificial intelligence.

“A lot of plans are trying to race toward this vision, but nobody’s there yet,” Seigel says. One of the biggest problems out there are the legacy systems still in use. These systems process billions of dollars’ worth of claims. It’s not something that is easily changed,” he says.

Seigel says health plans should be looking for ways to test out new strategies in small pilots, “to show the art of the possible.” Do a pilot for a discrete population, for example.

“In the short term, we advise our clients to get a 360-degree view of their members,” Seigel says.

Right now, very few discrete data sets are coming out of electronic medical records, according to Seigel. The reason for that is in the grand scheme of things, EMRs are relatively new and aren’t well codified and standardized. “Claims might have their warts, but generally speaking there’s a standard. For the most part, you know what you’re going to get,” he says.

Another problem is there is still a lot of the medical record captured via paper, Seigel says. Health plans are still chasing risk adjustment records and records for quality improvement and duplicating their efforts. This is causing provider abrasion, which could be reduced if plans could get smarter in a member-centric way. “Plans should ask themselves, how can we ask for this information just once, instead of multiple times?” Seigel says.

Making use of emerging technology is where plans need to be going in the short term, Cruse says. She acknowledges it’s hard to envision what it will take to get there, but other consumer-facing industries are taking the lead.

One day in the not-too-distant future, quality measurement will focus on what health plans want to measure, not on what they can measure, Cruse says. In the future, plans will be able to “sort the junk from the treasure” and use all the data available, including lifestyle and socio-economic data, to focus on the total well-being of a patient.

Cruse and Seigel recently published the study on Deloitte Insights, titled, “Creating a treasure trove of data for health plans: Shifting focus from disparate systems to a connected future.” It can be found here.

For reprint and licensing requests for this article, click here.