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Pushing Healthcare Data to the Front Lines

The healthcare industry generates huge amounts of data every day. In fact, it’s estimated that healthcare data accounts for about 30% of the world’s data volume. Health data is everywhere, but extracting information from that data—and getting it into the hands of the right people—is a different story.

The challenge is getting this data to the front lines—making it accessible, digestible and actionable for those in a position to influence health and financial outcomes.

Informing healthcare research

Although massive volumes of data exist, researchers often have a hard time accessing it. A current Medicaid data set, for instance, could provide researchers with valuable insights to improve the health of vulnerable populations. Unlocking this data and making it accessible to appropriate research groups is where both the challenge and opportunity lie.

Companies like Gainwell Technologies amass a tremendous amount of healthcare data that could be used in research relevant to the Medicaid population, whether the objective is controlling costs, improving outcomes, increasing access to care or addressing social determinants of health.

Gainwell, with client approval, makes de-identified data available to academic partners for a variety of research projects. This research is already yielding insights that can help states effectively run their Medicaid programs and address longstanding healthcare issues, including the opioid crisis.  

Providing greater visibility into MCO populations

A majority of states have turned to managed care organizations (MCOs) to manage the day-to-day care of their Medicaid populations, which can create an information disconnect. When states delegate control of their claims data and are not directly managing their recipients, it can be hard to see what is going on within their populations.

With the data that is available, however, states can use analytics to measure how well their MCOs are performing. MCO oversight analytics put data into a format that makes it easy for states to evaluate whether care quality and outcomes are improving across their networks.

States can then easily drill down into the information and compare performance across MCOs. Are some performing better than others? Is that a fair comparison (i.e., how do their populations vary)? Can best practices be identified and rolled out across all MCOs?  

From a policy perspective, data analytics can also help states determine whether policies they’ve set are appropriate and effective. Are the right policies in place? Are they having the intended effect? How should policies change based on the evolving needs and characteristics of each MCO and population?

Empowering care managers and teams

Integrating data and analytics into utilization and care management can help reveal cost-effective ways to deliver high-quality healthcare and better engage patients in their own care. Pushing this data out to entire multidisciplinary care teams—not just the health plan or payer and their care managers, but also the providers, caregivers and others working directly with Medicaid recipients—empowers those closest to the individual to impact health outcomes.

But while widespread access to information is vital, more so is the ability to put the information into actionable context. Using machine learning (ML) and artificial intelligence (AI), analytics can cue care managers with recommended next steps to improve individual or population health. Serving up data-driven next steps, rather than relying solely on the experience of the caregiver, could be profoundly useful to nurse care managers and behavioral health care managers on the front lines.

Risk analytics, combined with AI and ML algorithms, can offer insight into future risk at both the population and individual levels. This enables care managers to more effectively allocate resources and prioritize workloads.

Population health data can also be used to identify and overcome existing barriers to healthcare and the factors driving inequities in our systems. That data could help us take real, meaningful action on important issues, such as social determinants of health.

There is no shortage of healthcare data—the sheer volume of it is almost incomprehensible. Government entities and payers hold the key to unlocking the data by increasing the scope of data use agreements in ways that comply with privacy laws and regulations. Extracting useful insights from that data and making the information comprehensible to those who can put it to the greatest use is the key to realizing the value of healthcare data and empowering everyone to achieve positive outcomes.

Interested in learning more about using actionable data to drive positive change? Read the Gainwell white paper Demystifying healthcare data: Critical takeaways for unlocking the power of data-driven insights.