Ensuring timely and accurate clinical data communication to health plans on behalf of providers

Health plans measure care and service performance through the Healthcare Effectiveness Data and Information Set (HEDIS). Although many of the HEDIS measures can be generated by using
claims data, there is a requirement for the health plan to collect some clinical data from healthcare providers.

Historically, each plan has requested this clinical data using a variety of methods:

  • Request a fax of the patient chart
  • Request access to EHR
  • Request access to practice or hospital to review records
  • A custom data format

These request processes are often cumbersome for both plans and clinicians, particularly in a large healthcare marketplace. Take for example the Cincinnati-Dayton metroplex: Its multi-faceted healthcare landscape includes patients and systems located in three states: Ohio, Kentucky, and Indiana. Its 2.9 million people are served by seven major adult health systems, two pediatric health systems, many independent hospitals, and 6 commercial health plans, with no single plan having more than 25% market share.

The lack of a streamlined method in a large healthcare marketplace like Greater Cincinnati creates significant obstacles for providers and health plans as they collect and submit their data.

That’s where The Health Collaborative’s innovation comes in: we offer a HEDIS Reporting Service (HRS) to bridge the data gap between hospitals and health plans. This service ensures timely and accurate communication of clinical data to health plans for their members, and reduces disruption to clinical practices by eliminating the need for manual data requests.

Without HRS from The Health Collaborative, each health system would be required to submit data to each of the 6 health plans.

“For health plans, obtaining clinical lab values from providers is often costly and delayed by months, while the health systems experience frustration and increased workload from providing data manually and in separate formats,” says Jason W. Buckner, SVP, Informatics for The Health Collaborative.

The Health Collaborative is able to take this reporting burden off health systems by providing a centralized service for providers to submit patient data to health plans. Simply put, we provide a one-stop-shop for health plans to obtain clinical data in a single format from multiple health systems.

“We recognized there was a need in our region to do this more efficiently, and provide data more seamlessly. Now a health plan can receive HEDIS lab results for their members from several sources on a monthly basis, simply by supplying a member file. Our HRS is a win-win for both the health system and the health plan,” says Buckner.

As the healthcare landscape continues to change in our diverse region of providers and plans, The Health Collaborative will continue to develop innovative solutions like the HRS to solve some of healthcare’s toughest challenges.