Quality

Insights

Taylor Larsen

Healthcare Data Quality: Five Lessons Learned from COVID-19

Healthcare providers knew that COVID-19 would threaten the lives of their patients, but few understood the greater ripple effects across their business and industry as a whole. For providers, two significant COVID-19-induced challenges arose: analytic strain and resource limitations. These challenges highlighted the critical importance of data quality.
Healthcare leaders can improve data quality throughout their organizations by understanding the data quality lessons learned from COVID-19. Five guidelines from these lessons will help organizations prepare for the next pandemic or significant analytic use case:

Assess data quality throughout the pipeline.
Do not leave analysts to firefight.
Look outside the four walls of the organization.
Data context and purpose matters.
Use a singular vision to scale data quality.

Rachel Katz

Medicare Advantage HEDIS and Risk Reporting: A Primer for Providers

Medicare Advantage (MA) has exploded over the last 10-15 years, with the number of beneficiaries increasing by almost 400 percent in that timeframe. Provider groups have an increasing percentage of revenue and patients in MA plans and providers
are increasingly compensated based on HEDIS quality measures and risk scores through a combination of claims data and supplemental data. Submitting supplemental data can be critical to ensure providers receive credit for the quality of care they deliver and the true complexity of their patient population. Some plans have well-defined reporting programs, while others have little-publicized channels for reporting supplemental HEDIS and risk data. There are also significant bonuses that MA plans offer to providers for reporting, since the plan benefits immensely from receiving the data.
In this article, you’ll learn:

Why is HEDIS and risk data so important to health plans?
What is supplemental data?
And how do you as a provider organization report this data efficiently to earn incentives?

Daniel Orenstein, JD

Exceptions to Information Blocking Defined in Proposed Rule: Here’s What You Need to Know

Information blocking practices inhibit care coordination, interoperability, and healthcare’s forward progress.  The ONC’s proposed rule ushers in the next phase of the Cures Act by defining information blocking practices and allowed exceptions. To make the final rule as strong as possible, exceptions should be narrowly defined. In proposed form these include the following:

Preventing Harm.
Promoting the Privacy of EHI.
Promoting the Security of EHI.
Recovering Costs Reasonably Incurred.
Responding to Request that are Infeasible.
Licensing of Interoperability Elements on Reasonable and Non-discriminatory Terms.
Maintaining and Improving Health IT Performance.

This article covers each of these exceptions and discusses what to watch for in the final version of the rule.