Can Healthcare Embrace Data Aggregation to Support Value-Based Reimbursement?

Tuesday, May 13th, 2014
This post was written by Patricia Donovan

In order for value-based payment models to succeed, the system must support sophisticated data exchange between payors, providers, pharma and care management. Is healthcare ready for this challenge? Julie Schilz, director of care delivery transformation for WellPoint, responds from the payor’s point of view.

I can answer this in several ways. One is that right now, payors have clinical claims information. We can do wonderful things with that information. But how powerful it would be to be able to add clinical data from providers to enrich that claims data. And also to add information related to social determinants of health to truly create a picture of a member.

One of the reasons we were excited to participate in Comprehensive Primary Care initiatives is the component in which as a multi-payor structure we come together and define data aggregation. We bring our data forth to the practices who are selected to participate in the primary care initiative as payors, and are able to report in a consistent manner out to the practices.

This isn’t easy. There is hard work ahead of us; it is incredibly important work ahead of us. One of the discoveries we are making in this process, which we call ‘barrier busting,’ is to assure that everyone is in agreement in terms of the use of the data. Then we need to come together and decide: do we all have the same definitions around data use in our reporting structure? Is an attributed member for this payor the same as an attributed member for another payor? We must consider security of data; we have to assure privacy and security in the process.

We also know that it’s technically possible to exchange this data. For example, with the Continuity of Care Record (CCR), there are structures that exist in terms of how to share this data back and forth. But it still doesn’t always make it easy. There’s been some great work done by the Office of the National Coordinator for Health Information Technology. I was part of a program associated with that. There are many health information exchanges that are doing this work. There are all-payor claims databases that are forging ahead with this work.

It’s the right work to be doing, but it is not as easy as flipping a switch; there are governance structures, there are conversations, there are security structures that need to be in place in order for this to be successful.

Excerpted from: Driving Value-Based Reimbursement with Integrated Care Models

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