Looking to build a complete picture of your member’s health?

By Lesley Brown, SVP of Project Management at Halfpenny Technologies

The potential benefits to health plans of compiling a complete picture of their member’s health status are plentiful. 

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It really goes without saying that the more data and information you have about your members, the better help and guidance you can give them. You can ensure they receive the most appropriate and best care without unnecessary replication of services.  And importantly… without redundant costs!  For a long time, health plans have been reasonably content with the data that they obtain from medical claims.  But as payers become more engaged in actual care management and strive for value based care for their members, many are realizing that the data from claims offers only a part of this comprehensive picture.  Some of the pertinent detail, such as a lab test value, is often absent from a claim. Some care may not always result in an insurance claim.

The utilization of clinical data, such as that obtained from a continuity of care document (CCD) from a physician’s practice, can help enrich this health record for your members.  And the brilliant thing is – you do not need to wait for that first visit to the doctor with you as their medical insurer to occur.  If the member has remained with their doctor but changed insurance plans, their historical information will still be in their clinical medical record.

Unfortunately, gathering all this clinical data from multiple sources in order to take advantage of it is not as easy as it may sound.  There are many health information systems, such as EMR’s and LIS’s, that are in use by physician groups and hospitals. These medical record systems are built in a proprietary way in order to ensure a market share or niche for the vendor.  As a result, they use different templates and store common data elements in different formats. This is all thanks in part to variations in the interruption of industry standards.  Due to this variation these electronic record systems struggle to communicate with each other, never mind a vested third party that might be looking to take advantage of this goldmine of clinical data.  You’ve heard the term – there is a lack of “interoperability” in healthcare.  As a result, health plans that are interested in gathering this clinical data so they can compile a more complete picture of their member’s health are faced with a project that is time consuming, extremely expensive, and often results in failure.

Looking for some assistance in collecting clinical data?  Halfpenny Technologies (HTI) has been in the clinical data exchange business for more than 15 years. Over that time, HTI has built reusable interfaces that connect to 90%+ of the top EHR vendors and LIS/HIS systems.  HTI’s vendor agnostic approach allows the receipt of any EHR or LIS data format and in return health plans can receive clinical data in the layout of their choice. Halfpenny Technologies’ continued investment in innovative solutions has uniquely positioned the company as a national provider of clinical data exchange solutions to the health care industry.

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Going to the HIMSS 2016 Conference? Find us at booth #8033. Let us help you solve your complex interoperability challenges.

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What is the state of Clinical Data Exchange for Health Plans?

By: Lesley Brown, SVP Project Management at Halfpenny Technologies

As health care in the U.S. evolves, health plans and other risk bearing entities such as ACOs, have shown an ever increasing desire to acquire clinical data for their members.   This need is fast becoming more than a necessity, as value based care begins to drive reimbursements, revenue adjustment factors and quality performance, to name just a few.   While many health plans already have access to select quantities of clinical data (think Lab results, maybe even ADT data) their appetite is now evolving towards obtaining member Continuity of Care (CCD) data.  CCD is now heralded as the “superset” of clinical data, all the medical history, test results, medications for a member in one document.

Too bad then that the coordination and exchange of this clinical data from physician practice EHRs has become a significant pain point for many health plans and clinical data integration into payer systems has made minimal advancement in the past few years.  The challenges that health plans need to overcome range from technical ones, a lack of real clinical interoperability despite Meaningful Use (MU) Stage 2 and HL7 C-CDA requirements & specifications, to business ones, often a lack of clear business value and use case evaluation can stymie the best of endeavors.

Where and how to start?  Some of the common approaches payers can take for clinical data integration include building out point to point integrations (but who has time or resources for that!), accessing a state or local HIE (this is often limited by HIEs demands for standard data structures as well as a lack of data normalization) or partnering with one of a wide variety of vendors who claim they can facilitate non-claims based clinical data integration (many of whom fall short when attempts to validate data exchange are attempted).  Regardless of the integration arrangement health plans should be advised to start small and stay focused, successful data exchange projects have a value proposition and can demonstrate cost savings or increased revenue.  Examples include, risk adjustment factors that could benefit from the diagnosis list contained in a physician practice medical record or replacement of expensive chart reviews with defined data elements from an EHR.

Halfpenny Technologies (HTI) has been in the clinical data exchange business for more than 15 years and over that time have built reusable interfaces that connect to 90%+ of the top EHR vendors and LIS/HIS systems.  HTI’s vendor agnostic approach allows the receipt of any EHR or LIS data format and in return health plans can receive clinical data in the layout of their choice. Halfpenny Technologies’ continued investment in innovative solutions has uniquely positioned the company as a national provider of clinical data exchange solutions to the health care industry.

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Access to Actionable & Complete Lab & Clinical Results Data Enables Health Insurance Organizations to Improve Care Management

Health_plan_cardThrough truly interoperable lab and clinical data exchange, health insurance organizations (payors) can better manage individual care, support shared savings models, and deliver measurable and actionable outcomes.  Access to complete lab and clinical test results can help health plans drive down the cost of care and ultimately improve population.  Halfpenny Technologies offers comprehensive solutions to empower health plans with the right technology to tackle these initiatives and analytics tools for predictive modeling to address compliance and improve financial outcomes.

“Health plans struggle with the many challenges of health information exchanges and coordination of care,” Halfpenny Technologies President and CEO, Tim Kowalski, said.   “The clinical data integration solutions from Halfpenny Technologies, fuel health plans by giving them more complete access to the critical lab and clinical results data required for effective care management.  This data combined with powerful analytics and modeling tools empowers health insurance organizations to be more competitive and improve financial outcomes.”

Health insurance organizations are further burdened with constant challenges due to a rapidly evolving health care landscape fueled by change from compliance initiatives, health reform and an unstable economic environment.  To tackle these challenges, Halfpenny’s solutions provides access to clinical data and the necessary analytics tools to allow health plans to effectively manage patient risk and ensure better care coordination.  A health insurance organization’s ultimate success will be determined by its ability to:

  • Predict shifts in membership-base
  • Manage the cost of care
  • Collaborate more effectively with providers
  • Increase NCQA and HEDIS quality scores and Medicare Five-Star rating

Address health insurance organization’s need for complete clinical data

All health plans are facing the need to integrate clinical data such as lab results that is currently in disparate data warehouses across the enterprise.  Halfpenny Technologies aggregates, normalizes and consolidates laboratory and clinical test data so it can be seamlessly overlaid with quality report data, disease management data, population health data and claims data to gain holistic insights at the member level.

Tools to support collaborative care and shared savings models

Halfpenny solutions supports both the accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) models to help health plans to drive down the cost of care.  Our solutions toolkits focus on improving quality and controlling cost of care by aligning the interests of health plans, providers and members.  Additionally, Halfpenny Technologies health plan tools:

  • Promote evidence-based medicine
  • Provide comparative effectiveness
  • Enable the seamless exchange of data for better integrated care
  • Offer analytics to support pay-for-performance initiatives

Measure return on investment with Halfpenny Technologies’ analytics tools

Real-time data exchange between health plans and providers is paramount to enable collaborative delivery model operation and measurement.  With Halfpenny Technologies solutions, health plans can analyze outcomes and address compliance through automated reporting for patient centric care analysis & recommendations based on nationally accepted recognized clinical guidelines.

Halfpenny Technologies solutions help Health plans face the challenges in measuring the return on investment of programs that provide “difficult-to-quantify” savings, such as wellness, case, care and disease management.  The clinical decision support, population health and revenue enhancement reports enable health plans to work more closely with providers to coordinate care, develop performance metrics, and implement long-term data tracking systems and processes.

For more information on these solutions, please visit us at http://www.halfpennytech.com/health-plan.html

by Patricia Brown

Director of Marketing

Access to actionable lab data is essential for the success of care management for Health Plans & ACOs

Lab_data_health_plansHealth insurance and Accountable Care Organizations (ACOs) are faced with constant challenges due to a rapidly evolving health care landscape fueled by change from compliance initiatives, health reform and an unstable economic environment.  To tackle these challenges, health plans and ACOs need to develop go-to-market strategies and analytics solutions that define the organization’s future position and answer critical questions surrounding growth, profitability and sustainability. The ultimate success of these organizations will be determined by its ability to:

  • Predict shifts in their customer-base
  • Manage the cost of care
  • Collaborate more effectively with providers
  • Increase NCQA and HEDIS quality scores and Medicare Five-Star rating

Access to actionable lab data plays a significant role in the success.

Health plans utilize care management programs that typically implement a variety of interventions tailored to needs of specific groups of affected individuals.  A model that identifies those individuals who have high risk of complications has the greatest potential to impact outcomes and lower healthcare cost. Complete and real time lab results can help health plans model individuals who have high risk of complications, greatest potential to impact outcomes, and lower healthcare cost.

It is necessary for health plans to access to lab results to help them better determine the effectiveness of care management programs.   Some of the challenges and opportunities regarding lab data include:

  • Health Plans and ACOs typically experience difficulty receiving clinical data from labs.
  • Clinical data can have a significant impact on a health plan’s Medicare Five Star Rating, NCQA and HEDIS quality scores.
  • Health plans and ACOs seek laboratory data to reduce instances of drug contraindications, generate clinical alerts, and populate personal health records.
  • Lab results can demonstrate the efficacy of care management programs.
  • Ability to provide clinical data can be an important factor for a lab to achieve in-network status with a health plan or ACO.
  • Health Plans and ACOs share in a unique position to help a lab understand leakage (testing performed by out-of-network lab).

Health plans and ACOs need a true interoperability solution for lab and clinical data which can better enable their organizations to manage and lead in the coordination of individual care, support shared savings models, and deliver measurable and actionable outcomes that help health plans drive down the cost of care and ultimately improve population health.

Brian Muck is the SVP of Sales & Marketing for Halfpenny Technologies

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