Healthcare IT News: Integrating Claims and Clinical Data to Improve Population Health

Ken Yale, VP, Clinical Solutions, ActiveHealth Management

Until recently, technology-enabled efforts to improve population health relied heavily on the use of claims data alone. While there is evidence this approach has merit, there is also a new opportunity to take these efforts to the next level. The increased availability of other types of useful data—namely clinical data from electronic medical records and other systems—can help healthcare organizations fine-tune their analytics. As a result, they can better segment populations, improve quality, increase patient engagement – to successfully address population health needs.

Claims and clinical data naturally complement one another. Claims data has unmatched value in a complex and quickly evolving healthcare marketplace because it offers a retrospective look at what actually happened. In addition to revealing health facts about individuals and where to focus population health resources, claims data shows whether prescriptions were filled or if recommended lab tests were completed. Although the popular notion is there is a significant lag, new technologies allow claims data to be collected and assessed in a timely fashion – sometimes in less than 15 days. This generally gives providers sufficient time to react to a patient’s health needs. On its own, however, claims data does not provide the complete picture of a patient’s health when compared with a combination of the two types of data.