BY GEORGANNE CHAPIN
In health care, good data are essential to taking good care of people. Unfortunately, there”™s a “Data are from Mars, people are from Venus” type of thinking that goes on. It”™s like “The Odd Couple” characters, Felix and Oscar. Data play the role of Felix ”“ exact, consistent and correct ”“ while people behave more like Oscar ”“ disorganized, imprecise and unpredictable. This incompatibility is a challenge to providing high-quality care and customer service in the health care industry.
Here is an example. When people enroll in health plans on the New York State of Health marketplace (the “exchange”), their data are sent by the state to health plans, which have to reconfigure the data to import it into their systems. So if a new member immediately gets sick and calls the insurer to ask about benefits, the customer care representative might not have even the most basic demographic information on the new enrollee, due to the lag between signing up and getting into the insurer”™s system. The relationship between insurer and insured gets off to a rocky start.
That”™s why the nonprofit Hudson Center for Health Equity & Quality has made information technology the core of its advocacy work. We see a direct link between improving the quality and accessibility of health care, and access to quality and accessible data.
For a newly enrolled health plan member, a health plan”™s ability to manage data can make a real difference. The Hudson Center recently introduced a technology tool called Xchange Connect to help health plans use health exchange data more efficiently. Xchange Connect takes the data delivered from the state and quickly turns it into timely, actionable information. Insurers can see new enrollees, measure enrollment growth, reconcile payments and view enrollment status. And when people behave like people ”“ disorganized, imprecise and unpredictable ”“ health plans have the ability to set things right.
Xchange Connect also helps health plans determine if a new member has ever been covered by the insurer before. If that”™s the case, the insurer can connect all that member”™s records together. The tool can locate records if someone marries and changes her name, or sometimes uses her maiden name instead of her married name. The Hudson Center believes that by developing better data management tools to help health plans operate more efficiently, more money can be directed into care improvement. The Hudson Center also sees data management as crucial to helping health plans keep members covered. For example, it has systems for health plans that offer state-sponsored insurance, such as Medicaid and Child Health Plus, to automatically remind members to renew their enrollment; otherwise, that coverage could be lost.
Patient-centered data
We in the health care field have made enormous strides in collecting and connecting electronic health records. Thanks to groups such as the Taconic Regional Health Information Network Organization, providers can connect to each other to share patient records over multiple patient settings. This improves the quality of care and also reduces duplicate tests and screening.
Although electronic health records let providers know whether patients have been tested or screened, they can”™t tell why patients haven”™t gotten such services. Nor do providers gain much insight as to what is truly important to the patient as a person. That is why the Hudson Center has engineered a product called Insight Plus ”“ a system that captures patient data on who the patient actually is, what is important to the them and what”™s preventing the patient from getting the necessary care.
Insight Plus is now being used by a number of Medicaid “Health Homes.” Members of Medicaid Health Homes receive integrated care from physicians, behavioral health and/or substance abuse counselors and social workers ”“ all of whom need to talk to each other. Insight Plus, which we are now in the process of connecting to the Taconic health network, allows these different Health Home providers to communicate insights back and forth. This way, the Health Home team can determine a person”™s total risk profile and set priorities.
And that”™s what it”™s all about. The health care industry has only begun to tap the power of data to manage population health, discover new cures and deliver better care. But we have to keep in mind what the data really do is give us information about people ”“ people who rely on those of us in the health care system to keep them well.
Georganne Chapin is president of the Hudson Center for Health Equity & Quality and president and CEO of Hudson Health Plan, both based in Tarrytown.
