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Optimizing data use for PHM

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Anil Jain, M.D. writing in H0spitals & Health Networks, looks at how to access and use the data that are at the heart of population-health management (PHM) programs.

He notes that with the Medicare Access and CHIP Reauthorization Act, hospitals systems “are under increased pressure to support the Centers for Medicare & Medicaid Services’ Advanced Alternative Payment Models and Merit-based Incentive Payment System” and writes:

No one data source is going to provide a ‘gold standard’ for population health management. Claims data alone has often been used for PHM, but it is not timely, making it less useful for care management. In addition, because administrative and adjudicated claims data are not as rich as clinical data, both fail to provide a granular picture of clinical situations. Therefore, it is important to reconcile administrative, adjudicated claims and clinical data to optimally risk-stratify patients.’’

“Here are three key points to remember when building your data strategy for PHM’’:

  • “Start with an inventory of data sources and analysts who have expertise in accessing, extracting and curating the various data. This advice holds true whether you are developing your data strategy in house or working with a partner.
  • “Although it helps to have as much data as possible and to be able to combine different data types as needed into a common data platform, keep in mind that data-use agreements, privacy and security policies such as the Health Insurance Portability and Accountability Act and other constraints may limit your projects.
  • “Finally, iterate through your data projects with a few data types and incrementally layer on additional types as needed.”

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