The midterm election cycle has come and gone. A divided government means that it is highly unlikely that Congress, and specifically the House, will pass any monumental policies that would face defeat in the senate or a veto from the Executive Branch. What does this mean for healthcare and health policy in 2023?
Each year, the Verinovum team makes predictions about what the new year will bring for healthcare, and 2022 proved to be another eventful year. So, how’d we do in our New Truths of 2022 predictions?
Competitive pressures and complex regulatory plan performance reporting requirements create an additional challenge – acquiring correct and accurate data to demonstrate the best possible value to potential members, governmental agencies, and employer purchasers.
While a seismic shift in the administration, receipt, and payment for healthcare in the U.S. Quality has become a hot topic of discussion among stakeholders, change has been slow. The definitions of quality and value are rarely simple to quantify, and waste and error remain ubiquitous.
The U.S. healthcare system’s information technology infrastructure is a house of cards when it comes to interoperability and clinical data usability. Efficiently sharing patient and member information among clinicians, practices, payers, and patients is an ongoing challenge and this house of cards often collapses due to complex interoperability and data quality issues.
In this Q&A interview, Verinovum’s Chief Strategy and Marketing Officer, Mike Noshay, sat down with former NCQA Chief Information Officer Rick Moore to discuss current challenges around collecting healthcare data and how payers can unlock the right data at the right time to improve performance measures.
Payers typically have no shortage of clinical data at their disposal, with information from health screenings, health assessments, electronic health records (EHRs), clinician notes, test results, and more. But the quality of the data is suspect. In our experience, only about 40% of the clinical data our clients receive from providers or health information exchanges are usable, without need for curation and enrichment. The remaining 60% are inaccurate, incomplete, duplicative, or unstandardized. It requires various levels of curation and enrichment to make data standardized, accurate, and complete.
Black men face many risk factors for being diagnosed with prostate cancer, including a lack of access to healthcare, racial bias that can cause black men not to seek treatment, socioeconomic status, and delayed care. Yet if prostate cancer is detected at the early stages of development, the survival rate is 99%.4 The study's conclusion is that PSA screenings are not only more effective than scientists thought for the general population but benefit black men more than other races. Due to prostate cancer's prevalence in black men, they should be screened earlier and more frequently to monitor and mitigate their risk.
As the nation emerges from the COVID-19 pandemic, now is the time to reflect on and address the deficiencies in our healthcare system. In particular, the pandemic revealed stark truths about our healthcare information technology (HIT) systems with respect to racial and ethnic health inequities and our inability to collect and share patient data electronically between providers, payers, public health organizations, and other stakeholders.
As healthcare transforms, payers will increasingly incentivize providers to share health records for quality data reporting and to collect clinical data to improve population health, care management, and risk adjustment.