With a growing need to understand and measure accountability factors, company leaders are challenged more than ever to make the smartest possible choices to maintain a competitive edge while staying mindful of the bottom line. In a world where technology changes in the blink of an eye, keeping up is synonymous with keeping ahead. The healthcare industry is particularly susceptible to this idea.
As it implements its smart-business strategy through the use of Arcadia Healthcare Solutions data-integration technology, Community Health Network of Washington (CHNW), a nonprofit provider network, is using business intelligence to work smarter. Its platform combines clinical-provider data and health-plan claims data into one data warehouse, which enhances the ability to manage and drive performance improvement using robust, actionable reports.
As the parent organization of Community Health Plan of Washington (CHPW), a nonprofit health plan based in Seattle with 314,000 members, CHNW finds its decision to use the business-intelligence platform to be one of its smartest moves yet.
Comprised of twenty-one community health centers (CHC) throughout the state, the implementation of the program—which aggregates data from the EHR and health-plan claims data to drive overall improvement in both the cost and quality of care—has shown measurable success.
“Through the use of integrated clinical and claims data, we are able to better understand a patient’s gaps in care and provide actionable reporting to get them to their CHC medical home to be provided that care,” says CHPW/CHNW chief financial officer Stacy Kessel.
“It has allowed us to extract data from the CHC’s EHR, integrate it with CHPW’s claims data, and provide the care teams with a better ability to identify and target high-risk and high-cost members to manage chronic conditions and ensure that diagnoses can be more accurately assessed, managed, and documented.”
“It is more than just seeing what services are performed; it is seeing what isn’t being done and finding out why.”
Since spearheading the Arcadia partnership, CHNW has onboarded eleven of its twenty-one community health centers. “It is more than just seeing what services are performed; it is seeing what isn’t being done and finding out why,” Kessel says.
Business-intelligence metrics are able to help CHPW identify many factors within its plan. But Kessel tries to extract actionable data to improve the members’ quality of care and the accurate risk burden of the population in order to ensure appropriate funding is available to the CHCs, allowing for better health, better service, and lower costs for the communities that they serve.
Supplying useful information to providers that clearly outlines what patients are being treated for is essential to ongoing care. Because each CHC operates individually, comparing performance in quality measures can highlight areas of needed improvement for a specific CHC.
It can also identify areas where all the centers are struggling. “For example, what we found with most of the CHCs is that they weren’t consistently providing routine retinal eye exams for their diabetic patients. When we researched why they were struggling with this specific quality measure, we found out that many didn’t have the proper equipment in their clinics to complete the exam,” Kessel explains. “The remedy was to buy the cameras for the CHCs to use so they could complete the exam without having to refer the patient elsewhere for another visit.” Actionable data was the key to understanding the universal problem and finding a resolution.
By taking the integrated data and providing reports to its CHCs, physicians can track patients’ managed-care activity for the current year and treatment of any chronic conditions that require yearly consultation, evaluation, and managed care.
“If documentation of a chronic condition is not captured for a patient on an annual basis, then each new calendar year the system assumes that the chronic condition no longer exists, which results in a mismatch of funding in comparison to the member’s true risk profile,” Kessel says. “The condition must be assessed and documented each year in order to be recognized. Chronic conditions don’t just go away—they need to be managed. That information is one of the most important areas that business intelligence helps us to proactively capture and manage.”
Combining business-intelligence strategies with financial savvy and human compassion has been the source of CHNW’s drive for smarter, more effective business. Recognizing and creating a plan of action that will secure quality healthcare for its members is CHPW’s goal.
“I believe that everyone deserves the same access to quality healthcare,” Kessel says. “We are all people deserving of the same compassion and care.”
