The Power of Combining Clinical & Claims Data

Posted on November 16, 2017 I Written By

The following is a guest blog by Monica Stout from MedicaSoft

Whether the goal is to improve outcomes or increase efficiency, the healthcare industry finds itself searching for more and better data to support its efforts. Clinical data provides substantial details on patient encounters, but it is often difficult to assemble and integrate data from more than one healthcare provider. Claims data is better at following a patient across multiple care providers, but lacks information on patient health status and outcomes. Individually, both sets of data tell helpful stories, from chronicling the cost of care to reflecting how medicine is practiced. Together, clinical and claims data provide a fuller picture of a patient’s interactions with health care systems, the costs involved, and the results achieved. This larger picture provides the information that healthcare providers and insurers can use to guide their actions.

Assembling this data and making it available in a useful framework remains challenging. Data is not always available from providers and payers. When data is available, it is often not standardized (a particular issue with clinical data), making analysis difficult. So, how do organizations avoid investing time and money in efforts that fail to produce meaningful results? How do you make the data useful and improve patient satisfaction, care quality, and drive down system costs?

  1. Better data sharing agreements. Both providers and payers need more stringent data sharing agreements in place as well as insistence that they receive good data from plans.
  2. Address data quality issues head-on. Use real experts armed with specific tools to address any data quality issues within an organization.
  3. Use technology to help. Clinical data platforms can aggregate and integrate data into clinically relevant patient records, and claims data platforms extract relevant information from the complexity of the underlying claims data. Further, new advanced platforms help integrate clinical and claims data to support meaningful analytics.

Bringing together clinical data and claims data in a form that supports a variety of tools and analytics is key to the efforts of both healthcare providers and payers to improve outcomes, quality, and cost. This integrated data approach will yield better results than can be achieved with clinical or claims data alone. Stakeholders can and should leverage both policy and technology to develop solutions that produce meaningful results.

Are you combining clinical and claims data in your organization? What value have you gotten out of doing so? Why aren’t you doing it if you’re not?

About Monica Stout
Monica is a HIT teleworker in Grand Rapids, Michigan by way of Washington, D.C., who has consulted at several government agencies, including the National Aeronautics Space Administration (NASA) and the U.S. Department of Veterans Affairs (VA). She’s currently the Marketing Director at MedicaSoft. Monica can be found on Twitter @MI_turnaround or LinkedIn.

About MedicaSoft
MedicaSoft designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. MedicaSoft is a proud sponsor of Healthcare Scene. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.