New study from PwC says improved insurer-provider communication will lead to better patient care.
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If providers and insurers hope to improve medical care, they need to join forces to maximize the amount of patient data available to clinicians, said a recent report by PwC. Incorporating this larger pool of data into an organization will become critical as the landscape evolves into a more outcome-based approach.
According to the report, data can serve as a "powerful weapon" in the fight for constraining costs, but today's data tends to be trapped in silos, whether the pharmacy, the insurance company, the physician’s office, or the patient's computer. As a result, the benefits of informatics have largely bypassed the patient.
Insurance companies and providers alike hold "a treasure trove of data," according to the report; the merging of this data needs to occur to turn it into valuable information. A few have begun this transition, pulling together disparate sources of data. This includes early experiments into the formation of accountable care organizations, as well as the mobilization of health insurance exchanges.
Sean Morris, director of sales at Digitech Systems, echoed the report’s findings and said in an interview with InformationWeek Healthcare that two issues arise when it comes to forming solid partnerships between insurers and physicians: the technology and the lack of trust that exists between the two groups. Insurers and providers have historically not trusted each other, typically due to competing financial incentives in the current fee-for-service system.
"A wealth of specific and unique patient information resides separately in insurance company databases and physician databases," said Morris. "When that information is combined, a much more complete view of the patient is available to the physician, directly leading to improved patient care and better outcomes," said Morris. "[One] difficulty for insurers and physicians is… bridging this technology gap to employ systems that seamlessly share information.”
While the industry is moving away from individual care, which uses medical claims data to provide targeted single services, to personalized care, which aims to integrate the member’s unique clinical, social, genetic, and environmental information to maximize overall health, it’s yet to build the technology required to support this level of advanced knowledge, according to the report.
But the industry is getting there, and the first step is to use health information technology to marry member information held by insurers with "the deep clinical information collected by providers…" according to the report. This allows insurers to build a "deep, longitudinal patient record," resulting in a comprehensive view into patient history. For providers, this results in increased office efficiency and reduced medical errors, and it enhances quality-focused initiatives, such as Meaningful Use.
Data exchange, the report continued, has the potential to coordinate care and align reimbursement with improved patient outcomes. "From there, it is a much shorter step to the end goal of reducing costs while improving quality," the report read. Partnerships between insurers who have the technology capabilities and providers who have the clinical expertise, "creates the perfect combination of skill sets. This newly formed team can jointly establish methodologies for measuring effectiveness and reporting health outcomes, all designed to empower both the physician and provider."
Merging the amounts of information stored in the data warehouses of insurers and providers offers enormous potential to effectively target population health, the report concluded. "Going even further to incorporate pharmacy data, workplace information, community characteristics, and the patient's own observations can help make the promise of informatics a reality. There is no shortage of opportunities to innovate and be the next provocateur making tomorrow's industry headlines."
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