Value-Based Care Only Works if Healthcare Can Unify Claims & Clinical Data

Hector Flores, M.D., fights an often overlooked battle in Los Angeles, California. The physician serves a low-income, high-need Medicaid population. His patients face risks and challenges that people who live in mansions just a few miles away couldn’t imagine. For Flores to deliver high-quality value-based care, it’s imperative that he receive insights into his patients’ health at the population level.

But there’s a problem. In his small practice, Flores doesn’t have the resources of a large health system or payer, and as such, you might think he can’t have access to the data and analytics to execute a population health management problem.

You would be wrong.

Manifest MedEx is California’s largest nonprofit health data network and one of the largest health information exchanges (HIE) in the nation, partnering with 200 healthcare organizations, more than 80 hospitals, five of the state’s largest health plans — and even small provider clinics like Flores. Manifest MedEx delivers information from 11 million claims records and more than 5 million clinical records to power tools such as real-time alerts, longitudinal patient records and powerful population health platforms. They provide the kinds of insights required by healthcare organizations of any size.

Population Health Is Essential to Value-Based Care

More and more, healthcare has shifted its focus to population health. The field’s emergence as a top priority represents an even greater trend: the country’s transition to value-based care. In this new world, payers and providers alike are responsible for what happens to patients inside the clinic and what fails to happen outside.

“Gaps in data are gaps in insight, and gaps in insight hurt patients and slow progress in our healthcare systems,” says Manifest MedEx CEO Claudia Williams. “For ACOs and other kinds of value-based models to succeed in their critical missions of improving patient health, they need a complete picture.”

The network is fighting this problem by unifying provider and payer data, fostering collaboration between different stakeholders and delivering insights that can improve care, reduce costs and enhance health.

The major challenges of uniting healthcare providers and payers are receding, but it still isn’t easy. Manifest MedEx must aggregate and cleanse exorbitant amounts of data. There are data governance and standards issues that few wish to tackle. And the health data network can’t look for guidance to similar projects elsewhere in the country because their approach is totally unique.

“In order to find the smallest signal and sometimes the most impactful signal, we have to have a lot of clinical and claims data,” notes Erica Galvez, chief strategy officer of Manifest MedEx. “We have to sift through a lot of noise to provide the exact right piece of information at the right time that helps a provider smartly care for their patient”

So, why bother? Because without comprehensive, inclusive, insight-driven health data networks, value-based care is all but impossible.

Data Infrastructure Enables Population Health

In total, Manifest MedEx serves more than 10 million Californians, a task accomplished through any number of tools and partner organizations.

For instance, the network serves an accountable care organization that has found a lot of success in focusing attention on its 17,000 Medicaid beneficiaries’ hospital discharges. Who left the hospital today, what caused their stay and where are they headed next? Using Manifest MedEx information, the ACO customizes event notifications that flag only the insights that help answer these questions. Everything else is noise. As a result, their ACO has dramatically reduced hospital readmissions and healthcare costs for their patient population.

The nonprofit is capable of delivering similarly tailored information to a pediatrics practice that needs to know when patients with asthma visit the emergency department and care managers who must understand patient medication filling habits. And all partners are beginning to benefit from predictive analytics that enable better preparation for swings in hospital readmission numbers, costs and even mortality rates.

But how does Manifest MedEx get the job done? It all starts with data infrastructure.

“We had the good fortune of working with great technology partners,” Manifest MedEx Chief Technology Officer David Kates says. “InterSystems is the core and the foundation of our robust, scalable technology to aggregate and cleanse all that data.”

Manifest MedEx opted for a modular strategy to identify, store, analyze, normalize and access sweeping amounts of data. InterSystems HealthShare laid the groundwork for the longitudinal record, and InterSystems Health Insight created the data warehouse for the application of analytics.

That solid data infrastructure, combined with a secure tech platform and a deliberate method for combining claims and clinical data, ultimately leads to effective population health management that advances California’s largest insurers, physicians such as Hector Flores and patients across California. It’s the kind of bedrock that’s indispensable to making value-based care a reality.

Learn more about how InterSystems helps healthcare organizations extract value from data.

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