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The new reality for healthcare providers: Access to data is crucial; measurement is mandatory

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  By Kevin O'Mara,  October 24, 2011

ACOs, CINs and the transition to a patient-centered medical home model for both prevention and treatment are making data access crucial for physicians.

As the ideas of patient-centered medical homes (PCMHs), clinically integrated networks (CINs) and accountable care organizations (ACOs) move from concept to reality, health data must be readily available, easily analyzed and effectively deployed in a comprehensive and holistic manner. Health information technology companies have responded to this growing need by developing tools that help a wide variety of stakeholders better analyze and understand their data and measure their own results against published best practices. Having more data more easily accessible gives end-users a clearer understanding of both the cost and quality of care they offer compared to national standards founded on evidence-based research. By leveraging such data, providers can gain confidence that they are delivering the highest quality care and thus are working to improve health outcomes.

The passage of healthcare reform legislation and the increasing trend toward evidence-based medicine has placed data reporting and deployment at the forefront of the healthcare industry. At the physician level, having the ability to measure their own success against national benchmarks is not just important, but mandatory, under the Center for Medicare and Medicaid Services' (CMS) new ACO guidelines. At the same time that measurement and data access have become so important for physicians, competition for health services has never been more intense. With an older, savvier patient population utilizing more and more medical services — with the expectation that access be open and available — the need for easy access to data that measures and tracks against national guidelines has become a crucial component of a providers' practice.

Driving the need for increased data access and quality measurement are federal guidelines that seek to create and maintain high standards of care while reducing overall healthcare costs. Two designations in particular — ACOs and CINs — require that a practice measures its quality outcomes and uses data in an integrated, comprehensive way to improve patient care. The specifics for ACO and CIN designations differ, yet in both cases a practice must demonstrate that a quality improvement plan, measurement and data use are being leveraged to gauge their own care against national benchmarks. Such reporting is making diverse datasets ranging from medical and pharmaceutical claims to individual patient and clinical data vital for all providers wishing to achieve ACO or CIN status.

Both payers and providers have significant data at their disposal. Physician groups can utilize information related to the services that they provide, and health plans offer a comprehensive view of all services that a patient has received for a variety of conditions and from a wide array of providers. All of this data can now be cross-referenced to national standards and delivered in a consolidated dashboard that allows the physician to determine what the most effective course of action is for a particular treatment plan for a specific patient when measured against national best practices.

In modern, patient-centered healthcare settings, patients, payers and providers must share responsibility for ensuring that care is being managed effectively and efficiently, that best practices are being optimized and that costs are being controlled. Quality care can only be administered if appropriate measurement is available to track outcomes against nationally recognized standards, data and goals. There is a wealth of such information available that can aid a physician group in their overall population management strategy. Until recently, however, there has been a shortage of ways in which the provider could effectively view, analyze and deploy this data in a holistic manner. Provider access to such information is crucial to achieve the goal of improving health outcomes.

The market for data standards and utilization benchmarking is growing rapidly and couldn't be happening at a more important time for the industry. ACOs, CINs and the transition to a patient-centered medical home model for both prevention and treatment are making data access crucial for physicians. Such data is fast becoming a vital component of how healthcare providers must treat patients in order to deliver consistent, high-quality and cost-effective care that conforms to federal guidelines.

About the author

Kevin O'Mara is vice president of Product Management, HDMS. To learn more about HDMS solutions: http://www.hdms.com.

 


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