Yesterday's Becker’s Hospital Review contained an interesting article entitled "Five Things No One Told Me before I Launched an ACO", which interviewed five leaders of Accountable Care Organizations throughout the country. Of particular interest were the comments of Scott Hines, Co-Chief Clinical Transformation Officer of Crystal Run Healthcare in Middletown, N.Y, which is a physician-owned multispecialty group. Hines stated ” The biggest lesson that Crystal Run Healthcare ACO has learned to date is how integral claims level data is in helping to develop strategies to reduce cost and maintain quality”. Hines added that they were surprised to learn the amount of leakage from their facility to others, the costs of laboratory studies ordered by other physicians, and the significant contribution that post-acute rehabilitation made to the total cost of the care of their patients. He describes the strategic changes made in Crystal Run’s administrative and clinical operations as a result of discoveries in this data.
As this article points out, making effective use of claims data is critical to the success of any population-based healthcare initiative. Claims data is notable for its breadth in encompassing the wide group of providers who provide service to the patient population, as well as for its depth in presenting detailed cost and utilization information about the care to this population receives. As opposed to electronic health record (EHR) data which is in its beginning stages of adoption, analysis of claims data has been performed for decades and is a relatively mature process. Participants in the Medicare Bundled Payment for Care Improvement (BPCI) application process were frequently amazed at the level of detail obtainable about services provided by providers that was previously unavailable to them.
Medical claims data can be both voluminous and opaque, requiring significant processing capabilities as well as understanding of the intricacies of the coding and billing for healthcare services. When transformed into actionable information through the use of appropriate analytical and visualization tools, however, it can provide crucial strategic information that's critical to success of any population-based healthcare initiative.
Singletrack Analytics provides comprehensive claims data analytics for ACOs and similar organizations. See our Analytics for ACOs web page for more information.