Healthcare’s new era: Why administrative healthcare data is key
The changes have seemed endless. Since the early days of “Meaningful Use” electronic healthcare records incentives, to the recent switch to an expanded ICD-10 code set, the healthcare sector’s shift to a more standardized, tech-enabled ecosystem has been underway for almost a decade.
Frustrating and divisive at times, the industry’s changes remain incredibly important. Providers like Conduent are helping shape and forge these changes, working with stakeholders across the industry toward a common goal: enhanced quality of healthcare delivery, with better patient outcomes.
In the value-based healthcare system of the future, patients, providers and insurers alike will benefit from decreased costs stemming from better and more coordinated care. The key to more coordinated, higher-quality care is data.
Innovations in data use
Even as many stakeholders continue to question the digital transformation of the healthcare system, the benefits of better administrative healthcare data are already bearing out.
Researchers and technological innovators are diving into healthcare records in unprecedented ways – helping advance the potential for administrative data to lower costs of care and decrease rates of disease.
Using administrative data to understand the brain
Diseases and disorders of the brain and nervous system such as Parkinson’s and Alzheimer’s are hard to diagnose (and, so far, impossible to cure). Parkinson’s, for example, can be difficult to spot, with side effects – like depression and gastrointestinal trouble – that could result from any number of afflictions.
Improving the ways we identify and treat these conditions is key to combating the negative effects of neurological damage, and preventing problems like stroke and dementia. But conducting clinical research in the brain is not easy, which means our healthcare system lacks a comprehensive understanding of neurological disorders.
In the absence of high-value clinical data, the availability, and quality, of administrative healthcare data is proving vital in the fight against neurological conditions.
In fact, for students and scientists across many fields, health-records information can provide an ideal “secondary use” data set. Unlike data gathered from short-term clinical studies, administrative data is collected routinely (over time) as patients interact with their healthcare providers.
The information may be collected for purposes related to payment and reimbursement, making any research application a so-called “secondary use.” But that’s partly what makes it so reliable – because accurate billing is vital to providers, patients and payers alike.
This accuracy can help researchers not only understand rates of diseases but also better define their troubling side effects. For example, in an effort to better understand the levels of “neurotrauma” experienced in certain populations, one study investigated which ICD-10 codes were most indicative of brain and spinal cord injuries.
Healthcare solutions providers with the technology and expertise to skillfully mine and capture healthcare administrative data are proving pivotal in the industry’s ability to make big strides in this realm.
Predictive capabilities
The benefits extend further into potentially predicting the development of neurological diseases. Another recent study used de-identified Medicare data from 200,000+ people to better understand the onset of Parkinson’s disease.
Knowing that approximately 90,000 patients in their data set were diagnosed with Parkinson’s in 2009, the researchers looked at which diagnoses and procedural codes were the most common in their records in the years leading up to diagnosis.
Using that information, they could then develop an algorithm that scanned the records of all 200,000 people to “predict” which ones would subsequently be diagnosed with the disease – and achieved a remarkable 73% success rate.
Look-back studies like these could be replicated in many different medical contexts, enabling insurers to use artificial intelligence algorithms to spot problems before clinicians do.
Combining administrative data with clinical testing may be the ultimate sweet spot.
A New York Times report recently highlighted how genetic testing can allow patients to know if they’re on track to develop Alzheimer’s disease. If patient records could be scanned for certain signals of Alzheimer's (just as for signals of Parkinson’s), an algorithm could alert doctors to recommend genetic testing to patients.
And since early detection and intervention are proven to help patients experience better outcomes as they manage neurological conditions (or any number of medical diseases), utilizing data in this manner could improve patient health while driving extensive cost savings across the healthcare system – benefiting patients, providers and insurers.
The opportunity for using administrative data in preventive applications is practically limitless. So as our decade-long transition to a value-based ecosystem continues, we’re wise to remember how the long game will benefit healthcare stakeholders of all stripes.
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Serving over 2,000 hospitals, all of the top 20 managed U.S. healthcare plans, nine of the top 10 pharma and life sciences companies as well as 26 state governments, Conduent manages meaningful connections across the health system that modernize consumer experiences and – ultimately – improve business and health outcomes.
Conduent’s Care Integration Services can assess a provider’s defined patient population and identify at-risk patients based on insurance and pharmacy claims, data within electronic medical records and general demographic information. Clinicians and patient care coordinators develop health profiles for at-risk patients and provide assistance to support healthy outcomes, such as scheduling follow-up appointments or filling prescriptions.