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Private Payers News

Data Sharing Among Payers Advances Population Health Management

Health payers would benefit their beneficiary population as well as reduce unnecessary spending if health information exchange is conducted in a timely and efficient manner.

By Vera Gruessner

- When it comes to data collection and data sharing, payers should inform beneficiaries exactly how their information is used such as public health reporting requirements or among healthcare providers. The federal government offers a background to consumers about how their data is used through the health insurance exchanges on the website.

Health Information Exchange

The Centers for Medicare & Medicaid Services (CMS) ensures that all consumer data remains private and protected from cyberattacks. CMS follows all required standards and laws with regard to data security.

The federal government agency requires beneficiaries to enter in vital financial information in order to determine eligibility for a qualified health plan, insurance affordability programs, and any health plan exemptions.

A beneficiary’s information can be used to help identify as many cost-saving coverage solutions as possible while at the same time helping an individual resolve any issues or questions regarding an application for health insurance. Additionally, CMS uses beneficiary data to help manage payments of premium tax credits among the consumers.

Once an individual has enrolled in the health insurance exchanges, their data can also be used to combat healthcare fraud as well as respond to breaches of security on the insurance marketplace.

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There are several agencies that beneficiary information stored on the health insurance exchanges could be shared with. These include the Social Security Office to verify Social Security numbers, the US Department of Homeland Security to determine immigration or citizenship status, and the Internal Revenue Service to verify household income.

Whether offering health plans through the health insurance exchanges or through private employers, health payers would benefit their beneficiary population as well as reduce unnecessary spending if health information exchange is conducted in a timely and efficient manner.

Providers, payers, and vendors will need to work together to implement effective systems that allow for the exchange of numerous health data points. Health information exchange can play a large role in strengthening population health management and a healthy population can further chip away at rising medical costs.

The Colorado Comprehensive Primary Care (CPC) initiative is one example of effective data sharing. This community has implemented analytics and population health management systems from vendor Rise Health, according to a company press release.

“We have come a long way in a short time,” Dr. Judy Zerzan, the chief medical officer for Colorado Medicaid and administrator of COCPC, said in a public statement. “Our providers now have the integrated data they need to manage patients across multiple payers.”

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This data sharing platform will be used among 74 primary care practices and seven health payers to better serve a patient population of 94,000 beneficiaries throughout the state of Colorado. The primary care practices are able to implement Rise Health Ascend intelligence engine and Stratus predictive analytics application to view multiple payer reporting data all during the same period of web access.

Once the information is shared and accessed by multiple primary care providers, these facilities then use the data to achieve some of the goals of the Colorado Comprehensive Primary Care. Summary reports and quality metrics are some examples of the kind of data shared between payers and providers.

“This is the first time I’ve seen claims data turned into very actionable reports from a care management perspective,” Betsy Duckett, clinical care coordination manager for Boulder Community Health Ambulatory Services, stated in the press release. “The tool itself looks somewhat intuitive and easy to navigate.”

Several webinars and trainings were conducted in early May by Rise Health to ensure that providers and insurers were able to use the tools correctly. Primary care practices in Colorado joined the statewide project, which was initially based on the Comprehensive Primary Care (CPC) initiative, a program established across the country to improve primary care among private and public health plans. Many stakeholders in Colorado are hoping this program will expand and improve care coordination across the state.

“Having single source to access analytics across payers signals a new era for data-driven practice management,” Mark Crockett CEO Rise Health said in a public statement. “Colorado is taking the lead nationally in terms of being first to market with a solution for practices that includes multiple payers.”

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Vendors will need to support payers and providers in implementing effective health information exchange platforms and data analytics software. Data sharing between providers, payers, and beneficiaries is vital in the quest to strengthen population health management, reduce healthcare costs, and improve the quality of care.


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