3 Ways Payers Can Use HIT to Manage Population Health
Conclusions drawn from data mining and analytics are only as strong as documentation and initiatives surrounding quality documentation and auditing can account for under / inaccurate coding
2. Documentation and Data Integrity
How you can merge claims with community health claims with Blue Cross Blue Shield Community Health Management Hub
1. Integrated Data Claims
The use of opioid tracking in Dentistry to help control prescription opioid abuse across states. Bringing it all together for data and documentation.
3. Opioid Prescription and Abuse
Integrating Payer Claims: CC
Definition: Population health management - act of identifying and addressing the health of individuals within defined populations. In the payer world, this is done on behalf of the plan sponsors (e.g. employers, unions, markets) who purchase health insurance products on behalf of their members (i.e. patients).
Population Health Management & Payers (aka Health Plans)Like providers, Payers can aggregate and analyze data. Digitization supports how payers identify & monitor specific populations on behalf of plan sponsors (employers, unions) & plan members, for activities like:
Identifying gaps in care
Distinct advantage: payers can get a bigger picture of health care encounters across providers & systems, through claims data. Providers, facilities may not be able to see care outside of the EHR system. Payers can see high level information across health providers & systems based on claims data
Integrated Payer Claims Continued
Claims data however is not perfect. There’s the risk of GIGO - garbage in, garbage out. Dan will go into more detail of these risks. Data does not currently cross payers, so member data can get “lost” when a member changes health plans
Payers can optimize Pop Health opportunities in the following areas:
Coaching and Incentivizing providers
Telehealth for case management
Telehealth & mHealth together
Future challenges & considerations
Timeliness of data
The ins and outs:What goes in:Use of unspecified codesDischarge summariesMedication / patient historyWhat comes out:Ineffective clinical decision makingImpact on perception of qualityUnderpaymentsThe ins and outs:What goes in:Use of unspecified codesDischarge summariesMedication / patient historyWhat comes out:Ineffective clinical decision makingImpact on perception of qualityUnderpaymentsThe ins and outs:What goes in:Use of unspecified codesDischarge summariesMedication / patient historyWhat comes out:Ineffective clinical decision makingImpact on perception ofWhat Goes In:
Use of unspecific codes
The Ins and Outs
What Comes Out:
Ineffective clinical decision making
Impact on perception of quality
Chasing The Chart
A slice of the industry
Cost of a chart review
Over 120 mm enrolled in commercial or MA plans
"In the late 1990s, dentists were the top specialty prescribers of immediate-release opioids, accounting for 15.5% of all immediate-release opioid prescriptions. Thanks in part to policies on opioids and treating dental pain adopted by the ADA, the rate of opioid prescriptions written by dentists has decreased considerably in recent years. In 2009, dentists were responsible for 8% of immediate-release opioid prescriptions, and by 2012 this amount had decreased to 6.4%. However, the opioid crisis continues, and more must be done."
Come back in an hour!
Opioid Prescription and Abuse: Elizabeth
In March of 2018, the ADA released a new policy that supports mandatory continuing education on prescribing opioids, prescribing limits on opioid dosage, and a duration limit of no more than 7 days for the treatment of acute pain. The policy also recommends that Dentists sign up for Prescription Drug Monitoring Programs.
What is Being Done & Issues
What has been required
Not required to sign up for PMP.
So far, Virginia is only connected to 30 states.
As of January 2016, all newly licensed prescribers and pharmacists are automatically registered for the PMP but not those before.
No known reward or incentive for signing up.
Patient's don't know where to dispense unused opioids
Blue Cross Blue Shield Association. (2018, March 14). Blue Cross Blue ShieldAssociation Establishes the Blue Cross Blue Shield Institute to Reduce the "ZIP Code Effect" on Health. Retrieved
August 9, 2018, from https://www.prnewswire.com/news-releases/blue-cross-blue-shield-association-establishes-the-blue-cross-blue-shield-institute-to-reduce-the-zip-code-
Blue Cross Blue Shield Institute. (n.d.). When it comes to health outcomes, zipcode ismore important than genetic code. Retrieved fromhttps://player.vimeo.com/video/187251335?api=1
Emergency Department After-Hours Code [Web log review]. (n.d.). Retrieved August8, 2018, from https://tinyurl.com/ercodingpearls
Greene, A. H. (2018, July 27). How a rushed California law will change the privacy andsecurity landscape for mobile health apps. Retrieved fromhttps://tinyurl.com/yc4a8nf3
HealthITAnalytics. (2017, July 19). How Do Population Health, Public Health,Community Health Differ? Retrieved August 19, 2018, fromhttps://healthitanalytics.com/news/how-do-