eHealth Initiative Foundation Releases Final Report on The Use of Clinical Data by
Medicaid Managed Care Organizations
Washington, D.C. – April 27 – eHealth Initiative Foundation released their report, Improving Care and Lowering Costs: The Use of Clinical Data by Medicaid Managed Care Organizations, which interviewed executives from MCO organizations about the ways clinical data is collected, shared and leveraged. The report is available for download in the eHealth Resource Center.
“The interviews revealed that Medicaid plans are just beginning to use clinical data in case management systems and value-based contracts,” said Jennifer Covich Bordenick, Chief Executive Officer, eHealth Initiative Foundation. “The staunch challenges these executives face implementing an effective clinical data strategy is also clear.” Several key trends emerged and are explored in the report:
- Targeting high-risk members for intervention earlier. Executives are beginning to use clinical data to improve risk management analysis and predictions related to service utilization and cost.
- Sharing Clinical Data with Provider Networks. MCOs with a more advanced clinical data strategy reported that sharing clinical data with their provider networks is a critical component of value-based contracts.
- Technical Immaturity. Many executives stated that their current infrastructure does not support their clinical data strategy and operational requirements.
- EHR Limitations. MCOs experience challenges with the variability found in EHR systems and the sheer volume and types of data available.
- Limited Access to HIEs. While HIEs are a key source of accessing and distributing data, some payers have been slow to adopt this practice because of uncertainty about who is responsible for HIE fees, the payer or provider.
- Concerns from Providers. Providers may be hesitant to share information with MCOs for managed care purposes due to a belief that it will lead to decreases in payments and profit loss.
“The key trends identified in this report highlight the enormous challenges MCOs face in the modern healthcare marketplace,” said Gary Christensen, General Manager for public sector initiatives for InterSystems. “However, the progress these organizations have made toward better sharing, collecting, and using clinical data is also clear – and should be commended.” eHealth Initiative’s research and work on value-based care was supported by Intersystems, the engine behind the world’s most important applications. The company’s InterSystems HealthShare software enables managed care organizations to aggregate and share near real-time clinical data to augment coordinated care management, enhance and automate business processes, and reduce costs.
The report was discussed in a webinar on April 26. Presentation slides and a recording of the webinar are available for download in the eHealth Resource Center.
About eHealth Initiative
eHealth Initiative (eHI) & Foundation is a Washington D.C.-based, independent, non-profit organization whose mission is to drive improvements in the quality, safety, and efficiency of healthcare through information and information technology. eHI is the only national organization that represents all stakeholders in the healthcare industry. Working with its membership, eHI advocates for the use of health IT that is practical, sustainable, and addresses stakeholder needs, particularly those of patients. www.ehidc.org.
About InterSystems
InterSystems is the engine behind the world’s most important applications. In healthcare, finance, government, and other sectors where lives and livelihoods are at stake, InterSystems is the power behind what mattersTM. Founded in 1978, InterSystems is a privately held company headquartered in Cambridge, Massachusetts (USA), with offices worldwide, and its software products are used daily by millions of people in more than 80 countries. For more information, visit InterSystems.com.