The Validated Data Stream designation boosts the value of Datavant’s services. Validated Fast Healthcare Interoperability Resources (FHIR®) data streams undergo a rigorous, end-to-end examination of data quality and integrity and the procedures used to manage and safeguard it. From the initial intake at primary sources to the transmission to end users, it ensures compliance with NCQA processes, system requirements, and data standards. This involves thoroughly examining documentation, data capture, integrity checks, mapping, and workflow resilience.

“We consider this important designation a valuable and mutually advantageous investment in our partnership with health plans,” said Datavant Chief Product Officer Shannon West. “As a recognized Digital Quality Trailblazer, collaborating with NCQA to shape these new standards enabled us to streamline and road-test enhancements to our platform early and verify value to our health plan customers.”

NCQA data validation goes beyond advancing the digital landscape, addressing trust concerns, and unlocking health data value. It removes the need for Primary Source Verification (PSV) in HEDIS reporting. Health plans benefit from the time and cost savings and reduced audit burden by utilizing DAV-validated data, avoiding complex administrative tasks.

“Most interoperability discussions focus on technical challenges, like formats for data exchange,” says NCQA Chief Product Officer Brad Ryan. “Data Aggregator Validation is about something bigger: ensuring people across organizations can trust the data that drives high-quality care and value-based reimbursements.”

Learn more about .

About Datavant

Datavant protects, connects, and delivers the world’s health data to power better decisions and advance human health. Datavant is a data logistics company for health care whose products and solutions enable organizations to move and connect data securely. Datavant has a network of networks consisting of thousands of organizations, more than 70,000 hospitals and clinics, 70% of the 100 largest health systems, and an ecosystem of 600+ real-world data partners. To learn more about how Datavant brings data logistics to health care, visit . For media inquiries, please contact: pr@datavant.com

About NCQA

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website () contains information to help consumers, employers, and others make informed health care choices. NCQA can also be found at Twitter and on LinkedIn at .

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Ongoing changes in reimbursement put immense pressure on healthcare providers. Two challenges identified by RCM (Revenue Cycle Management) leaders as significantly impacting financial stability and operational efficiency are staffing shortages and an escalating volume of claims denials. As the volumes and complexity of denials increase, RCM leaders grapple with the increased workload while striving to retain dollars to improve financial performance.

For many healthcare providers, existing solutions do not allow for sufficient denial workflow, management, or analytics. The scarcity of staff, equipped with the requisite skillset, further exacerbates day-to-day struggles in managing denials.

It is crucial for healthcare organizations to adopt a comprehensive denials management solution that blends the power of specialized staff and innovative technology. This synergy empowers organizations to navigate the complexities of denials and streamline revenue cycle process with fewer people, positively impacting the bottom line.

The Impact

Health plan policies are changing more frequently, forcing healthcare organizations to defend their documentation when denials occur. Ongoing changes in reimbursement put immense pressure on healthcare providers to manage the increasing denial volume while maintaining financial performance.

Denial Rates: In the first quarter of 2023, . This trend is not expected to change in 2024.

Productivity and Efficiency:  There is a significant effort and cost for a provider to resolve a denial in its favor. A lack of qualified staff and updated technology may also play a part.

Delayed Payments: Although most denials are eventually paid, the denial itself delays payment. A third of inpatient claims submitted by providers to commercial insurers were not paid for over three months. Even Request for Information .

The Solution

A comprehensive denials management solution offers a strategic combination of people and technology to address the challenges posed by staffing shortages and to streamline the denials management process.

Optimized Staff Allocation: With the rising demand for staff to manage denials, healthcare organizations often struggle to allocate their resources effectively. Specialized staff trained in denials management, optimizes staff allocation based on the organization’s specific needs. Dedicated teams lead to reduced overhead costs and improved workforce efficiency.

Maximized Technology Integration: Software that seamlessly integrates with existing RCM systems, empowers organizations to leverage the latest technological advancements without disrupting operations. Software should enhance staff productivity, enabling them to focus on critical tasks while automating repetitive processes, leading to increased accuracy and faster claim resolutions.

Proactive Denials Prevention: A comprehensive program should go beyond simply managing denials after they occur. RCM software should identify potential denial triggers by analyzing historical data and industry trends to empower staff with insights to prevent denials. This proactive approach saves valuable time and resources by reducing the volume of denials and preventing revenue leakage.

Datavant’s Denials Program: Protect – Connect – Deliver

Datavant’s all-encompassing approach to revenue cycle protects revenue by connecting an experienced team with technology to deliver a positive impact to the bottom line. Datavant’s comprehensive denials management solution goes beyond addressing the mounting challenges of RCM staffing; it embraces a consultative approach, delivering a transformative combination of skilled staff and state-of-the-art technology. By partnering with Datavant, healthcare organizations can navigate the complexities of denials management, elevate their revenue cycle performance, and achieve sustainable financial success amidst the dynamic healthcare landscape.

Datavant’s unique value proposition lies in the embedded presence within hundreds of healthcare providers and health systems, fostering profound insights into revenue cycle needs. Leveraging the extensive data on denials collected through release of information (ROI) services and robust relationships with health plans and healthcare provider organizations, Datavant offers unparalleled assistance in tackling denials.

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In this blog post, we step back to paint a picture of why secure health data exchange matters, and Datavant鈥檚 evolving role in light of recently strengthening our digital Release of Information (ROI) network and technology offerings, as well as our expanded impact outside of ROI, including into supporting value-based care organizations.

Why Health Data Exchange Matters

Moving health data with the proper authorization and driving meaningful action from that data remains much more burdensome, complicated and costly than it needs to be today. When patient health data can instead be securely accessed, released and connected to additional data seamlessly:

• Patients聽have a better understanding of their health, and an improved ability to shape their own care journeys
• Providers聽have a more complete view of their patients and more time to spend with their patients, leading to improved continuity of care and clinical decision-making
• Risk-bearing organizations聽better monitor the quality, outcomes, and cost effectiveness of patient care, while shifting care from reactive to proactive
• Researchers聽pursue novel questions, connecting high-value datasets with the consent of the participating organizations

This benefits the entire U.S. healthcare ecosystem for the better, closing millions of care gaps and helping us to more rapidly improve the quality and lower the cost of care.

Enabling Secure Exchange Without Sacrificing Operating Efficiency, Cost or Risk

Our Release of Information (ROI) offerings ensure the right health information is moved outside of provider organizations to the right requesters at the right time. We have been committed to partnering with providers to securely share patient data outside of their organizations for 40+ years, enabling the exchange of more than 60 million patient records per year.

Our digital ROI network has now reached more than 70,000 U.S. hospitals and clinics, with new capabilities enabling providers to leverage digital fulfillment regardless of which EHR they use. Where digital connectivity is deployed, providers benefit from:

• More satisfied patients: Unlocking rapid access to their records, rather than spending hours trying to navigate healthcare organizations
• More effective doctors: Obtaining information necessary to ensure continuity of care and make proper care decisions
• More efficient Health Information Management (HIM) professionals: Fulfilling digitally minimizes the need for manual processes, increasingly critical amidst persistent labor market concerns and cost pressures
• Less friction from requesters: Reducing calls and faxes repeatedly checking status of record requests due to 8x faster fulfillment
• Less compliance risk: Improving quality control processes guarantees zero Unauthorized Disclosures (UADs)

To complement digital ROI, providers continue to leverage our ROI and professional staffing services to minimize the time and cost challenges of manual workflows elsewhere in the data exchange process. These services deploy best practices for compliance and efficient operating procedures, based on learnings from thousands of provider environments.

Our ROI offerings are available at no cost to providers, and can open opportunities for future financial benefit. These offerings complement your investments in EHRs to extend and accelerate the expected operational and financial gains.

Datavant also partners with Finance and Revenue Cycle Management professionals to drive faster, more accurate payments and remove administrative waste through our coding and denials services and technology tools.

Streamlining Intake by Meeting Requesters Where They Are

Providers intake a large influx of disparate requests for patient data every day. These requests come from a diverse set of requesters and through many forums 鈥� including mail, fax, calls, walk-ins, emails, and EMRs or other web-based portals. This is administratively burdensome, creates friction with requesters and distracts from providing patient care, especially during high-volume periods such as Medicare Risk Adjustment seasons.

At Datavant, we have built a variety of technology tools to help healthcare organizations manage these different requests, including:

• Patient Request, a white-labeled Release of Information (ROI) authorization tool that supports millions of patients each year to efficiently request access to their records
• Provider Continuity of Care Request, an easy digital alternative to the fax- or phone-based request methods still favored by many providers (below)
  
• Request Manager, a tool enabling 星空无限传媒-managed payer requests to be viewed in one streamlined digital user interface vs. as discrete payer fax requests (below)
  

In addition to streamlining workflows for healthcare organizations, these tools greatly improve the experience for requesters.

Driving Value in Value Based Care

As our healthcare system shifts into value-based care models, access to complete, high-quality medical information is necessary. Accountable Care Organizations and Managed Service Organizations need to access patient health data from the hundreds of hospitals, practices and clinics they work with. Traditional providers engaging in risk-bearing strategies have increasingly become requesters of patient health data. These value-based care organizations seek to advance their data strategies, better understand their patient populations, close care gaps and improve risk management.

To meet these evolving needs, Datavant鈥檚 offerings have extended into this space:

• We now connect data digitally from more than 1500 providers to value-based care organizations, enabling the ability to assess the quality, cost and outcomes of care being provided by those practices and clinics
• By releasing and retrieving health data in a standard format, we can partner with organizations to create standard data lakes to unlock operating efficiencies, minimize risk and pave the way for new value-added use cases
• Our ability to securely connect de-identified health data from an ecosystem of more than six hundred real world datasets, enables organizations to better understand their patient populations longitudinally, paving the way for more effective management of population health and participation in research

These capabilities ultimately enable a healthcare organization鈥檚 ability to close care gaps, improve the quality of patient care and lower the cost of care. By pairing these capabilities with more efficient Release of Information, we鈥檝e seen leading ACOs and MSOs unlock new efficiencies and value for their organizations.

Conclusion

Securely moving precious patient health data improves clinical decision making and patient experience. Datavant鈥檚 digitized network, modern technology tools and complementary services enable providers to achieve this without sacrificing operating efficiencies or costs. Contact us聽to learn more.

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Stratum Med organizations intend to implement Datavant鈥檚 technology and integrated services for Release of Information by leveraging Datavant鈥檚 ability to pull standardized electronic health record (EHR) data from over 60 EHR systems in a timely, secure and compliant manner. Using these connections to feed the standard data lake will also allow Stratum Med to take advantage of Datavant鈥檚 capabilities and ecosystem to bring in additional third party data in a de-identified manner to further increase patient insights.

The data lake, which Stratum will retain full control of, will provide Shareholders visibility to patient populations to expand value based care initiatives, increase risk predictability, improve clinical decision making and close care gaps. This clinical integration will also extend opportunities for closer connectivity to clinical trials and life sciences projects.

鈥淒atavant was already providing Release of Information services for several of our Shareholders. When we learned of the opportunity to expand Datavant鈥檚 digital technology to additional Shareholders in order to simultaneously facilitate the creation of a data lake that Stratum would own, control, and use to improve the outcomes of the patients we serve鈥t was a logical next step to support our strategic initiatives,鈥� said Trent Kramer, President, Chief Executive Officer for Stratum Med.

鈥淒atavant has the largest ecosystem of data exchange in healthcare and it is so exciting to work with organizations like Stratum Med that share in our mission to improve patient outcomes by elevating data exchange to data empowerment鈥�, said Pete McCabe, Chief Executive Officer for Datavant.

About Stratum Med

Since 1996, Stratum Med, headquartered in Champaign, IL, has specialized in bringing together disparate medical groups in order to achieve success for the last 25+ years in a variety of verticals through collaboration. Owned by 17 large independent multi-specialty group practices, Stratum has remained physician-owned and physician-led expanding their reach nationally through successfully sustained relationships with over 100 medical groups and approximately 12,000 physicians and counting. Midwest-based with national outreach, Stratum aims to facilitate groundbreaking medical innovation and collaboration between high-achieving medical groups, and leverage group buying power to decrease costs. Learn more about Stratum Med at .

About Datavant

Datavant鈥檚 mission is to connect the world鈥檚 health data to improve patient outcomes. Datavant works to reduce the friction of data sharing across the healthcare industry by building technology that protects the privacy of patients while supporting the linkage of patient health records across datasets. Learn more about Datavant at .

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鈥淭ogether, Datavant and Healthjump will dramatically accelerate the process of controlled, compliant clinical data exchange for healthcare organizations across the country,鈥� said Pete McCabe, Chief Executive Officer of Datavant. 鈥淭his is the underlying infrastructure that is necessary to close millions of care gaps every day, to allow better and more rapid clinical and operational decision-making, and to enable the move to care arrangements designed around improved patient outcomes.鈥�

Datavant is the largest provider of Release of Information services in the country, serving more than 65% of the top 200 US health systems when they have a need to provide patient medical records to authorized requesters, including patients, providers, researchers, attorneys, and health and life insurers. Since its merger with 星空无限传媒 Health two years ago, Datavant has emerged as the leader in digitizing the process of patient data exchange, laying down hundreds of APIs in collaboration with its health system partners, and quickly moving towards the majority of patient information requests being fulfilled digitally with the entire process overseen by our expert managed services team.

Healthjump is the leader in health data exchange for value-based care organizations, enabling its customers to pull standardized electronic health record (EHR) data from participating practices and clinics regardless of which EHR systems they use. This information is used by value-based care organizations to assess the quality, cost and outcomes of care being provided by those practices and clinics. “Healthjump has made it possible to get and use data that we otherwise would never have had. We’ve closed several thousand care gaps with that healthcare data and are looking forward to the future with Datavant” said Adam McClellan, Vice President, Strategic Development & Implementation at Community Care of North Carolina, Inc. Healthjump鈥檚 application is a guided thirty-minute installation that has been completed by more than 1500 practices and clinics, and is HITRUST certified. The combined company will operate under the name Datavant.

鈥淲e are thrilled to join the Datavant team,鈥� said Cliff Cavanaugh, Chief Technology Officer of Healthjump. 鈥淲e鈥檝e been working in partnership for years in pursuit of parallel use cases, all limited by the same essential problems of health data liquidity. Healthjump has developed an elegant and scalable solution which can be implemented out of the box across Datavant鈥檚 customers and partners. Together, we can enable provider organizations to address their information release and exchange needs holistically, supporting the pursuit of high-quality, cost-effective care and improved patient outcomes.鈥�

About Datavant

Datavant鈥檚 mission is to connect the world鈥檚 health data to improve patient outcomes. Datavant works to reduce the friction of data sharing across the healthcare industry by building technology that protects the privacy of patients while supporting the linkage of patient health records across datasets. Learn more about Datavant at .

About Healthjump

Founded by Martin Aboitiz, Cliff Cavanaugh and Jim Rowland, Healthjump is at the forefront of resolving the data liquidity challenges of traditional interoperability, serving over 1,500 clinical sites through its cloud-based platform. Healthjump revolutionizes the way EHR data is collected, standardized, and delivered, by eliminating the limitations and complexity of conventional interfaces. Our simple installation process alleviates the IT burden of complex EHR interface engines, empowering organizations to seamlessly transition to value-based care and leverage tools that enhance both patient and provider outcomes.

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• Analytics and reporting: Seamless data exchange allows providers to analyze patient information from various sources to improve clinical outcomes, track quality metrics, and evaluate financial performance.
• Population and health management: Interoperability facilitates population and health management through risk stratification, care coordination, and targeted interventions.
• Switching EHRs: Interoperability eases transition between EHR systems by ensuring secure data migration and continuous data exchange during the process.

By embracing interoperability, healthcare providers can enhance patient care, streamline operations, and foster innovation in the healthcare industry.

What is Interoperability in Healthcare?

Interoperability in healthcare refers to the secure exchange of health information between different healthcare systems, applications, and devices. It enables various stakeholders within the healthcare ecosystem, such as hospitals, clinics, laboratories, pharmacies, and insurers, to share and access:

• Patient data
• Clinical information
• Population health data
• Administrative and billing information

Interoperability aims to offer authorized users access to relevant and accurate data, regardless of the specific technology or platform being used.

Why is Interoperability in Healthcare Important?

In an increasingly interconnected world, the importance of interoperability in healthcare cannot be overstated. The ability to exchange patient data across diverse healthcare systems and applications has become paramount for:

• Bettering patient outcomes: Access to comprehensive patient data allows for coordinated care, reducing medical errors and improving patient safety.
• Empowering medical research: Access to a broader pool of patient data promotes the discovery of new treatments and therapies, ultimately improving public health outcomes.
• Surveilling public health: Real-time public health surveillance enables early detection and response to disease outbreaks and other health emergencies.
• Streamlining administrative processes: Efficient data exchange simplifies administrative tasks, such as processing insurance claims and minimizing paperwork, leading to reduced healthcare costs.

By nurturing a comprehensive ecosystem that connects stakeholders in healthcare, interoperability helps elevate healthcare to heightened standards.

Examples of Interoperability in Healthcare

Electronic Health Records (EHRs)

Electronic Health Records (EHRs) are one of the most significant applications of interoperability in healthcare. EHR data are digital versions of patients’ paper medical charts, containing comprehensive health information from various healthcare providers and facilities.

Interoperability enables seamless , ensuring that critical patient information is available to authorized providers regardless of their location.

Health Information Exchange (HIE)

Health Information Exchange (HIE) is a vital application of interoperability that facilitates the secure exchange of health information among various healthcare organizations and providers. HIE platforms serve as intermediaries, enabling the exchange of EHR data, diagnostic test results, imaging reports, and other relevant clinical data in a standardized and secure manner.

This interconnected network of data exchange plays a pivotal role in transforming the way healthcare is delivered, fostering collaboration and data-driven decision-making.

Medical Devices Integration

Medical devices integration bridges the gap between medical devices and EHR systems. Interoperable medical devices can seamlessly communicate with EHRs, enabling the automatic exchange of patient data, real-time monitoring, and streamlined documentation.

This integration enhances patient safety, clinical decision-making, and the overall efficiency of healthcare delivery.

Implementing Interoperability in Healthcare

Implementing interoperability in healthcare requires planning, collaboration, and adherence to industry standards. As healthcare organizations strive to enhance data sharing and communication between systems, successful interoperability implementation can pave the way for improved patient care, streamlined workflows, and transformative advancements in the healthcare industry. Key considerations for effectively implementing interoperability include:

• Adopting standardized data formats: Standardized data formats, such as HL7 FHIR (Fast Healthcare Interoperability Resources), are crucial for ensuring consistency and compatibility between different healthcare systems. Embracing standardized formats enables seamless data exchange, minimizing data transformation challenges during integration.
• Developing data governance and security policies: As interoperability involves sharing sensitive patient information, healthcare organizations must implement strict data access controls, encryption, and authentication mechanisms to protect patient privacy and comply with regulatory requirements like HIPAA.
• Investing in interoperable technologies: , including EHR systems, medical device interfaces, and health data ecosystems. These technologies should be capable of integrating with existing systems and able to securely exchange health information.
• User training and education: Healthcare professionals and staff must receive comprehensive training on using interoperable systems effectively. Education programs should focus on data entry, retrieval, and understanding the value of interoperability in enhancing provider operations.
• Continuous evaluation and improvement: Post-implementation, ongoing evaluation and monitoring help identify areas for improvement, address user feedback, and optimize data exchange processes.

Implementing interoperability in healthcare requires a strategic and collaborative approach. By adopting standardized data formats, robust security measures, and interoperable technologies, healthcare organizations enhance data sharing, provider operations, and better patient outcomes.

Next Generation Interoperability in Healthcare

Interoperability in healthcare brings together data, technology, and collaboration to enhance patient care, boost medical research, and streamline healthcare processes.

星空无限传媒 offers Datavant Switchboard to facilitate the secure exchange of health information, streamlining processes, enhancing efficiency, and prioritizing privacy and security.

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Traditionally, patient data has been stored in disparate systems, creating information silos across healthcare organizations. This fragmentation poses a significant challenge for healthcare providers striving to deliver patient-centric care. This lack of interoperability in healthcare results in:

• Inefficient Care: Without access to comprehensive patient records, healthcare providers may need to duplicate tests and procedures, leading to inefficiencies and increased healthcare costs.
• Missed Opportunities: Critical medical insights may remain hidden within the siloed data, leading to missed opportunities for accurate diagnoses and timely patient interventions.
• Delayed Care: In emergency situations, the time taken to locate and access crucial patient information can negatively affect health outcomes and, in some cases, become a matter of life or death.
• Patient Frustration: Decreased patient satisfaction over the frustration of repeatedly providing medical history to different healthcare providers, leading to a diminished sense of trust in the healthcare system.

Health information exchange platforms offer a transformative solution that bridges the gaps in patient information and facilitates modern patient-centered care.

What is Health Information Exchange (HIE)?

Health information exchange (HIE) is the secure and seamless sharing of patient medical information electronically between healthcare organizations, such as hospitals, clinics, laboratories, and physicians’ offices. Healthcare providers use HIE to access crucial patient data at the point of care, regardless of where patient records originated.

HIE empowers healthcare professionals with reducing medical errors, enhancing efficiency, and improving patient outcomes.

Benefits of Health Information Exchange

By facilitating the secure and seamless exchange of patient data, health information exchange empowers healthcare professionals to work collaboratively and provide more efficient, patient-centric care, while working at the top of their license.

Time and Cost Savings

Health information exchanges offer providers numerous opportunities to reduce costs, improve efficiency, and enhance patient care. The seamless exchange of health information empowers providers to make informed, data-driven decisions, avoid unnecessary expenditures, and ultimately deliver more cost-effective and high-quality healthcare services.

Here are some key examples of how HIE leads to time and cost savings:

• Minimized Administrative Burden: HIE streamlines administrative tasks, such as manual record retrieval and faxing. This automation reduces administrative workload for healthcare staff, freeing up valuable time that can be redirected towards patient care, ultimately improving operational efficiency.
• Reduced Paperwork and Storage Costs: HIE reduces the reliance on paper-based record-keeping and physical storage, saving providers expenses related to printing, postage, and physical space for record storage.
• Telehealth Cost Efficiency: HIE facilitates telehealth services by providing real-time access to patient data during virtual consultations. Telehealth can lower costs associated with in-person visits, such as travel expenses, and optimize healthcare resource utilization.

Enhanced Care Coordination

Health information exchanges allow healthcare providers to access a patient’s comprehensive medical history, including diagnoses, medications, allergies, and lab results. This comprehensive view helps providers make informed decisions, avoid duplicative tests, and provide more effective patient-centered and longitudinal care.

Coordinated care involves the collaboration and communication among different healthcare providers to deliver comprehensive and seamless healthcare services to patients. Here are some examples of coordinated care in action:

• Prenatal Care and Delivery: A pregnant woman receives coordinated care from her obstetrician, a maternal-fetal medicine specialist, and a pediatrician. The obstetrician shares the patient’s prenatal medical records, ultrasounds, and test results with the specialists through HIE. This ensures that the specialists are well-informed about the pregnancy and any potential risks. After delivery, the pediatrician receives information about the baby’s health, facilitating continuity of care for both mother and child.
• Care for Elderly Patients: An elderly patient with multiple chronic conditions receives coordinated care from their primary care physician, cardiologist, pulmonologist, and geriatrician. These providers collaborate through HIE, sharing information about medication changes, test results, and treatment plans. This coordinated care approach helps manage complex health issues effectively, preventing medication interactions and ensuring appropriate interventions for the patient’s overall well-being.
• Integrated Mental and Physical Health Care: A patient with depression and diabetes benefits from coordinated care between their primary care physician and a behavioral health specialist. Through HIE, both providers have access to the patient’s medical and mental health records, allowing them to address both conditions simultaneously. This coordinated approach leads to better management of the patient’s mental health and improved diabetes control.

Improved Patient Care

By accessing a patient’s medical history through health information exchanges, healthcare providers can make more accurate diagnoses, leading to reduced hospital stays, unnecessary treatments, and cost control. This results in significant benefits for both healthcare organizations and patients.

Here are some examples of patient empowerment in action:

• Reduced Duplicate Testing: When healthcare providers have access to a patient’s comprehensive medical history through HIE, they can avoid redundant tests and procedures. This not only saves time for both patients and providers but also reduces unnecessary healthcare costs.
• Improved Medication Management: With HIE, providers can access a patient’s medication history, reducing the risk of prescribing duplicate or contraindicated medications. This optimization of medication management enhances patient safety and prevents costly adverse drug events.
• Efficient Referral Management: HIE streamlines the referral process, allowing primary care physicians to share relevant patient information with specialists electronically. This expedites the referral process and reduces wait times for patients, improving their overall healthcare experience.

Health information exchange is a game-changer for modern healthcare. By breaking down information silos, ensuring the secure exchange of health information, and promoting collaborative care, HIE empowers healthcare providers to deliver patient-centric, efficient, and high-quality healthcare services.

Leveraging Health Information

Health information exchange not only improves patient care and outcomes but also offers a plethora of applications to optimize provider operations. Healthcare providers can leverage HIE data to streamline processes, enhance revenue cycles, and drive efficiency across the healthcare ecosystem.

Release of Information (ROI) Management

HIE simplifies release of information to authorized parties. Healthcare providers can securely share medical records, test results, and treatment summaries with patients, other healthcare facilities, insurance companies, and legal entities. Secure exchange of health information include:

• Digital Patient Medical Records Requests
  • HIE enables patients and authorized requesters to submit medical records requests digitally through secure web portals or integrated systems.
  • Patients can initiate requests remotely, reducing the need for physical paperwork or in-person visits to healthcare facilities.
• Data Retrieval through APIs
  • HIE leverages Application Programming Interfaces (APIs) that allow health systems to implement unique processes for data sharing.
  • APIs ensure standardized access to patient information while maintaining data security and compliance.
• Digital Data Delivery to Authorized Requesters
  • HIE systems provide rapid and automated delivery of patient data to authorized requesters within minutes of verification.
  • Real-time access to updated patient information enables better-informed decision-making during patient consultations.

This efficient release of information minimizes administrative burdens, expedites decision-making, and enhances overall patient satisfaction.

Medical Coding, Classification, and Quality Reviews

Health information exchange provides access to comprehensive patient data, including diagnostic information and treatments. This wealth of data enables accurate medical coding and classification of medical services provided to patients. Improved coding accuracy ensures:

• Proper billing
• Reduced claim denials
• Optimized reimbursement

Utilizing HIE data enables healthcare providers to conduct coding quality reviews more effectively. They can assess the accuracy of medical codes assigned to patient encounters, identify potential coding errors, and implement corrective measures.

This proactive approach fosters compliance with coding standards and regulations, resulting in improved financial performance and risk mitigation.

Clinically-Integrated Revenue Cycle (CIRC)

Health information exchange that facilitates a clinically-integrated revenue cycle approach, connects clinical and financial data and processes. By integrating patient health information with billing and revenue management systems, healthcare organizations can optimize revenue cycles, minimize revenue leakage, and expedite claims processing.

The CIRC approach also requires close collaboration between clinical and financial staff, allows healthcare organizations to improve the quality of their clinical documentation, which in turn leads to fewer denials and improved reimbursement.

Here are a few key takeaways to having a CIRC approach:

• Integration of clinical and financial data and processes.
• Quality improvement of clinical documentation.
• Revenue cycle optimization and expedited claims processing.
• Close collaboration between clinical and financial staff.
• Patient care improvement and overall efficiency of healthcare organizations.

Ultimately, the CIRC is an approach to revenue cycle management that can help healthcare organizations improve their financial performance and deliver better care to their patients.

Electronic Transfer and Exchange of Clinical Records

Health information exchange (HIE) platforms enable providers to access patient health information electronically for better patient care and across a patient’s longitudinal health care journey. This can help to ensure that patients receive the right care at the right time, and it can also help to reduce administrative delays.

For example, when a patient changes their healthcare provider, their medical records can be securely transferred to the new provider, ensuring continuity of care across their health care journey. This can help to reduce the risk of errors and omissions in the patient’s medical record, and it can also help to improve the quality of care that the patient receives.

Workflow Management Tools

Integrating HIE platforms in conjunction with workflow management tools enhances transparency between stakeholders, allowing the larger health system to work more efficiently from end-to-end administrative processes streamlined care.

For example, workflow management tools can be used to automate the scheduling of appointments, the ordering of tests, and the reporting of results. Automating administrative tasks in healthcare reduces risk and ensures timely completion, leading to enhanced patient satisfaction.

Gathering and Storage of Health Information

The gathering, storage, and retrieval of health information within health information exchange platforms are meticulously designed to ensure a seamless flow of data among healthcare providers. Through electronic capture, structured storage, and secure retrieval processes, HIE platforms empower healthcare professionals with timely access to comprehensive patient information.

How Health Information is Gathered

Health information is initially gathered through or electronic medical records (EMRs) within healthcare organizations. These records contain a wealth of patient data, including medical history, diagnoses, treatments, medications, lab results, and imaging reports.

As patients receive care from various healthcare providers, their data is entered into these electronic systems, capturing a comprehensive snapshot of their medical journey. This electronic capture streamlines the data gathering process and minimizes errors that can occur with manual record-keeping.

How Health Information is Stored

Once health information is gathered, it is securely stored within HIE platforms. These platforms utilize robust data centers equipped with advanced infrastructure to ensure high availability and data integrity.

Data is typically stored in structured formats using databases that allow for efficient indexing and retrieval. This structuring enables healthcare providers to access specific patient information quickly when needed, even if it originates from different healthcare organizations.

HIE platforms employ redundant storage systems and regular backups to safeguard data against loss or system failures. This redundancy ensures that patient information remains accessible, even in the event of a technical issue or disaster.

How Health Information is Exchanged

Healthcare providers can retrieve patient data from HIE platforms when granted access. Pulling and retrieving data involves secure authentication and verification to ensure that only authorized individuals can access patient information.

Authorized providers use APIs to connect to HIE platforms or designated interfaces and retrieve the required data. These interfaces facilitate the seamless transfer of data while maintaining the necessary security measures.

When a healthcare provider requests specific patient information, the HIE platform locates and pulls the relevant data from the databases. The data is then securely transmitted to the authorized provider, ensuring the confidentiality and integrity of the information during the transfer.

Ensuring Privacy and Consent

Throughout the gathering, storage, and retrieval processes, patient privacy and consent are of paramount importance. Health information exchange platforms adhere to stringent privacy regulations, such as the in the United States, to protect patient confidentiality.

Before accessing patient data, healthcare providers must obtain explicit consent from the patients. This consent ensures that patients have control over who can access their health information and for what specific purposes. Patient privacy rights are respected, and data is securely handled in compliance with legal and ethical guidelines.

Health Information Security

Health information exchange platforms place utmost importance on data security and compliance to safeguard sensitive patient information. To maintain the confidentiality, integrity, and availability of health data, HIE employs robust security measures and adheres to regulatory requirements. Here’s how HIE ensures data protection:

• Secure Data Encryption: HIE platforms utilize strong encryption protocols to protect data during transmission and storage. Data encryption ensures that information exchanged between healthcare entities remains confidential and unreadable to unauthorized individuals, reducing the risk of data breaches.
• Role-Based Access Controls: HIE implements role-based access controls, allowing only authorized personnel to access specific patient information based on their roles and responsibilities. This approach ensures that healthcare providers can only access data relevant to their clinical duties, maintaining patient privacy.
• User Authentication and Verification: HIE employs multi-factor authentication methods to verify the identity of users attempting to access patient data. This authentication process ensures that only authorized individuals can access the system, mitigating the risk of unauthorized access.
• Audit Trails and Monitoring: HIE maintains detailed audit trails, recording every data access and modification, along with user actions within the platform. This level of monitoring allows for continuous oversight of data interactions, enabling rapid detection and response to any potential security incidents.
• Compliance with Privacy Regulations: HIE adheres strictly to relevant privacy regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States or the General Data Protection Regulation (GDPR) in the European Union. By following these regulations, HIE ensures that patient data is handled in a compliant and ethical manner.

Health information exchange platforms need to prioritize security, privacy, and compliance. Proactive approach to risk assessment, data governance, and employee training ensures a safe and compliant environment for exchanging sensitive health information, safeguarding patient privacy, and trust.

Secure Exchange of Health Information

Health information exchange presents a powerful solution to the challenges of fragmented health information, revolutionizing patient-centered care in the modern healthcare landscape. By leveraging health data ecosystems that offer the secure exchange of health information, your organization can streamline processes, enhance efficiency, and improve patient outcomes through secure and seamless data sharing.

Contact us to securely exchange health information across providers, payers, requesters, and patients.

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With primary care as the focus, the Making Care Primary model aims to:

• Improve patient outcomes
• Increase access to healthcare
• Reduce costs

The key components to the success of the Making Care Primary model hinges on data, interoperability, integration, and technology. Let鈥檚 examine these topics and what health plans can do.

Interoperability vs. Data Integration for the Making Care Primary Model

At first glance, it鈥檚 easy to think that interoperability and data integration are interchangeable. However, they are nuanced in their definition.

The defines interoperability as health information technology that 鈥�(A) enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user; (B) allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and (C) does not constitute information blocking as defined in section 3022(a).鈥� Or, more simply put, healthcare organizations can send, receive, find, and integrate data from outside sources.

Some consider data integration the last mile of interoperability. defines data integration as the mechanism for transforming and integrating data from multiple sources into a targeted destination environment. It ensures that the data reaches the intended recipient in a usable format.

One can see how both are needed for the Making Care Primary model. As a health plan, it’s imperative you ask others within your organization how they differentiate interoperability and data integration. There will likely be various answers ranging from low levels of integration to higher. To ensure your organizational priorities are successful, confirm early that everyone has the same understanding.

Data Integration to Support the Making Care Primary Model

With the objectives set for the Making Care Primary model participating Medicaid agencies and health plans can prepare by asking the following data-related questions.

• Where are data sources coming from (internal or external)?
• Where is the data stored? And who鈥檚 using the data?
• Does the enterprise have the technology and resources to implement things like predictive analytics?
• How will the organization integrate unstructured data (e.g., social determinants of health data)?

Collecting answers to these questions will:

• Break down internal silos
• Gain organizational alignment
• Create a culture of sharing
• Lead to better processes and workflows

Using Natural Language Processing (NLP) to Facilitate Data Integration for the Making Care Primary Model

Integrating external data can be challenging, but incorporating unstructured data like SDoH can pose an even bigger challenge. Executives at use NLP with artificial intelligence and machine learning concepts to extract unstructured SDoH information from patient records and convert it to a structured format.

While still relatively new, initial results are positive with approximately 30% of NorthShore鈥檚 population having at least one SDoH factor in unstructured text. NorthShore has also identified 56% more at-risk patients who are experiencing SDoH gaps. This according the the article linked above.

Much Has Been Done

However, there is still much to learn on how to best utilize clinical and SDoH data as it becomes more accessible and secure thanks to interoperability and integration. There are preliminary steps to take within your health plan:

1. Agree on where all data resides
2. Review resources (people, processes, and software) to identify gaps
3. Look at technology like AI and NLP to incorporate unstructured data sets
4. Determine if you can handle AI and NLP internally or need to establish a contract with an external vendor

Better patient outcomes, lower costs of care, and optimized encounters are just the tip of the iceberg for the potential that lies ahead as health data becomes fully digitized and compliantly accessible.

星空无限传媒 Health utilizes the Datavant Switchboard to supply compliant access to structured and unstructured clinical data electronically. This coupled with 星空无限传媒 Data Utilities (data supplementation capabilities for SDoH member data) and the NLP AI powered coding engine Cross Check, offer the complete data solution for health plans participating in the Making Primary Care initiative, or planning to participate in the future.

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What is Denial Management?

Denial management is the systematic process of identifying, analyzing, and resolving claim denials in healthcare organizations. It involves activities such as:

• Identifying denials
• Analyzing root causes
• Resolving denials
• Submitting appeals
• Implementing process improvements
• Taking corrective actions

By effectively managing denials, revenue cycle managers ensure financial stability and smooth operations for their organizations.

Key Actions to Manage Denials

There are several key actions that can be taken to ensure successful denial management. These include:

• Identifying Denials: Revenue cycle managers must closely monitor claims to identify denials promptly. By categorizing denials based on common reasons such as coding errors, missing documentation, eligibility issues, or medical necessity, you can gain insights into the underlying causes and prioritize your efforts.
• Analyzing Denials and Identifying Root Causes: Analyzing denial trends is essential for understanding the root causes of denials. By performing root cause analysis, you can identify patterns and systemic issues contributing to denials. This analysis helps in developing targeted strategies and process improvements to prevent similar denials in the future.
• Submitting Appeals: Resolving denials and submitting appeals are vital steps in denial management. Revenue cycle managers work closely with coding and billing teams to gather necessary information, such as additional documentation or coding clarifications. Timely and accurate submission of appeals within payer guidelines is crucial for maximizing reimbursement.
• Optimizing the Denial Management Process: To minimize denials, it is essential to implement process improvements and corrective actions. Collaborating with other departments, such as coding, billing, clinical documentation improvement, and provider relations, allows for addressing systemic issues and enhancing communication to prevent denials.

Denial Management Strategies

Healthcare organizations can implement a number of denial management strategies to proactively address denials, minimize revenue leakage, and enhance the overall revenue cycle management process. These include:

• Maintain Clinical Documentation Integrity: Accurate clinical documentation forms the foundation for capturing the true clinical picture, serving as the source of truth. Healthcare organizations need to actively identify and target areas for improvement in:
  • Documentation
  • Code specificity
  • Clinical documentation integrity

This active approach aims to optimize chart quality, enhance completeness, and support better patient care.

• Educate and Train Staff: Providing education and training to staff involved in the revenue cycle process is key to reducing denials. By enhancing coding knowledge, documentation practices, and understanding of payer policies, staff can avoid common errors and improve denial prevention strategies.
• Analyze Data: Analyzing denial data and generating reports help identify denial trends and measure the effectiveness of denial management efforts. By leveraging data analytics tools, revenue cycle managers can track denial metrics, identify patterns, and make informed decisions for improvement.

Denial Management Services

星空无限传媒 offers denial management services designed to support revenue cycle managers and directors, offering holistic, multi-discipline approach to denials prevention and management.

• Denial Prevention and Analysis: 星空无限传媒 helps identify denial patterns, analyze root causes, and develop targeted strategies for prevention. By leveraging advanced analytics and industry expertise, 星空无限传媒 provides insight to reduce denials and optimize revenue cycle performance.
• Denial Retrospectives and Appeals Assistance: 星空无限传媒 offers expertise in managing the denial resolution and appeals process. The team works closely with providers to gather necessary documentation and submit appeals to maximize reimbursement.

Denial management is an ongoing process that requires collaboration, continuous improvement, and the utilization of technology solutions. By staying vigilant, understanding denial trends, and implementing targeted strategies, healthcare organizations can strengthen revenue cycles and optimize reimbursement for long-term success.

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• Economic stability
• Education
• Social and community context
• Health and healthcare access
• Neighborhood and built environment

How to Use SDOH Data

The World Health Organization (WHO) believes . By integrating SDOH data with clinical and claims data, researchers, healthcare providers, and payers can gain a more comprehensive understanding of patient populations, enabling them to develop targeted interventions and allocate resources more effectively.

Example: COVID-19 disproportionately impacts African American, Hispanic, and low-income populations

Studies have indicated on African American and Hispanic populations, as well as socioeconomically disadvantaged groups.

By incorporating SDOH data, insights showed the disproportionate impact of COVID-19 on African American, Hispanic, and low-income populations, including:

• African Americans and Hispanics make up a larger than expected share of both cases and deaths.
• Households earning less than $49k annual income showed higher than expected representation in both cases and deaths.

Researchers Enhance Predictive Analytics with SDOH Data

Big data in healthcare has the power to transform patient care and patient outcomes. Using SDOH data with other empowers researchers to run predictive analytics, gain insights, and make more informed decisions.

By analyzing patterns, healthcare organizations can:

• Identify at-risk individuals and communities
• Predict future health outcomes
• Implement preventive measures

For instance, by examining factors such as income, education levels, and access to nutritious food, healthcare providers can identify areas with higher rates of obesity and diabetes and develop targeted interventions to combat health issues.

Predictive analytics can also be used to optimize care management and resource allocation. By identifying patients with complex needs or those at risk for re-admission, healthcare providers can focus their efforts on high-risk patients, improving care coordination and reducing unnecessary hospitalizations.

Example: SOURCE Collaborative explores non-healthcare factors that may impact blindness from diabetes

By , SOURCE found that lower levels of affluence in a patient’s residential community was associated with progression to blindness.

This allowed them to speculate several causes such as:

• Limited access to healthy foods
• Lack of parks or difficulty finding places to exercise
• Lack of eye care professionals in those locales

Analyzing social determinants of health alongside other patient data harnesses the potential of big data analytics, driving advancements in healthcare research and improving patient outcomes on a broader scale.

Payers Deploy Targeted Care Using SDOH Data

Payers increasingly leverage SDOH data to meet health equity requirements and enhance care delivery:

• Tailored Member Programs: Payers develop specialized initiatives like nutrition delivery services and transportation to and from medical appointments.
• Identifying Care Gaps: SDOH data helps payers identify gaps in care for underserved communities, enabling strategic in-home assessments and interventions.
• Future Risk Adjustment Models: Centers for Medicare & Medicaid Services (CMS) plans to incorporate SDOH-related Z codes into risk adjustment models, recognizing the significance of SDOH data in assessing healthcare needs.

Payers’ consideration of SDOH underscores their commitment to improving health equity, delivering targeted care, and addressing disparities for vulnerable populations.

Example: CDPHP supports physical and mental wellbeing with non-medical assistance

, partnering with Papa, to combat loneliness and isolation in older adults, families, and other vulnerable populations. CDPHP aimed to address:

• Social isolation
• Loneliness
• Transportation barriers
• Gaps in care

By integrating SDOH data, CDPHP enhanced their services to deliver comprehensive care for its Medicare Advantage members.

Providers Optimize Value-Based Care Using SDOH Data

Value-based care organizations face challenges in fully understanding their patient panel. SDOH data can significantly assist providers in addressing these challenges and improving patient care:

• Onboard Patients Into Care Programs: Providers use SDOH data to identify patients who require additional support and connect them with appropriate resources.
• Stratify Patients by Risk: SDOH data combined with clinical information helps identify high-risk patients, enabling targeted interventions and resource allocation.
• Manage Transition of Care: SDOH data informs post-discharge plans, considering social factors to support smoother transitions and reduce readmissions.

By leveraging SDOH data, providers gain a more comprehensive understanding of their patient population, leading to more targeted and personalized care interventions.

While accessing SDOH data offers significant advantages, challenges can arise from:

• Lack of Interoperability and Uniformity: Data exists in fragmented sources like electronic health records (EHRs), public health databases, social service systems, and proprietary databases. Integrating and securing data while ensuring data integrity and confidentiality can be complex.
• Lag in Payer Claims Data: Payers can take weeks or months to release claims data. This delays informed decision-making, care improvement, analysis, and performance evaluation.
• Incomplete Data Sets in Health Information Exchanges (HIEs): Not all healthcare providers or organizations participate in HIEs. This reduces the available data pool. Moreover, varying data sharing policies result in data gaps or inconsistencies.

Overcoming these challenges require robust data integration strategies, standardization efforts, and access to health data ecosystems to ensure comprehensive and timely access to SDOH data.

Maintaining Privacy Around SDOH Data

While the benefits of using SDOH data are undeniable, it is crucial to . Healthcare organizations must adhere to strict data privacy regulations such as:

• The Health Insurance Portability and Accountability Act (HIPAA)
• The General Data Protection Regulation (GDPR)

These regulations ensure that patient data is handled securely and confidentially, minimizing the risk of unauthorized access or data breaches.

To maintain privacy when using SDOH data, healthcare organizations should:

• Implement robust data governance policies
• Establish clear
• Utilize advanced

By following these best practices, organizations can leverage SDOH data while safeguarding patient privacy.

Health Data Ecosystems Containing SDOH Data

Organizations can access a wealth of SDOH data through the . Datavant connects disparate data sources, empowering organizations to gain a comprehensive view of patient populations, uncover new insights, and drive better outcomes.

Datavant ecosystem provides access and connectivity to various data sources, including:

• SDOH data
• Clinical data
• Claims data
• Patient records
• Radiology images

SDOH data holds immense potential in transforming healthcare and addressing health disparities. With Datavant, healthcare organizations can , empowering them to make data-driven decisions and improve patient outcomes.

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