Article
Towards the next generation of health plan and provider data sharing
April 5, 2019 · Authored by Michael J. Patti
Article abstract
Enhanced data exchange between health plans and providers would lead to a fundamental shift in the quality of medical care. But incorporating new data exchange technologies has been a struggle for plans and providers because it requires new processes, new models, and new capabilities. Most providers’ five-year capital plans focus on improved market share and new care venues while not acknowledging the data-sharing demands of value-based care. Providers also should conduct an independent review of their current risk readiness and performance management tools to assess and quantify the long-term objectives for their organization. Continue reading to learn more about this potential new world.
Imagine a world where data exchange between health plans and providers is fully integrated. A world where health plans and providers engage in real-time data sharing at the point of service; where providers are able to access the entirety of a patient’s clinical and administrative data to support decision-making; where new patient data is automatically uploaded and accessible to clinicians and plan administrators.
It’s a world where data flows as close to the source as possible, bi-directionally, in real time; where operational business processes and tools are aligned across the various health plans or providers; where data is centralized and is accessible at the points closest to the decision-maker. This is a world where clinicians enjoy unprecedented access to practical and actionable insights; where clinical observations support recommended actions and where health plans and providers collaborate to produce optimal patient outcomes. Allowing patient outcomes to improve as they receive well-informed and more efficient care.
The benefits of a world characterized by enhanced data exchange between health plans and providers would allow for a fundamental shift in the quality of medical care. Health plans and providers would experience less complexity in interactions with their counterparts, which would lead to fewer disputes regarding the validity and interpretation of data. Health plans and providers would also realize significant efficiency benefits which, in turn, would help better manage their operational costs and better serve their clients.
Achieving such a world is possible, however there are several hurdles to overcome to achieve such an outcome outside of the data interoperability challenge. Legal/privacy issues, central storage, limited provider participation and the question of who manages the data and the costs, just to name a few; however, this is the future considering the ongoing evolution and progression towards value-based care models.
