For health plans, managing disparate data is complex, costly, and resource-intensive. Member data is consolidated from multiple sources: medical claims, PBM/RX, care management, family history, business intelligence (BI) and analytics outputs, labs, health coaching, disease category, and eligibility.
Having member health readily available is a paramount concern for health plans. It is used to coordinate and personalize care to close gaps and improve health outcomes by:
- Assigning members for care management or programs as an output of BI/analytics work
- Identifying risk and Social Determinants of Health (SDOH)
- Managing incentives
- Building cohort groups
- Merging data with electronic health records
- Aligning communications preferences
Leading vs Lagging Data
Client data can be categorized as Lagging or Leading. Both may look accurate, but lagging data is dated …many times weeks or even months old. Leading data is acquired in near-real-time, giving your plan the ability to act on the findings immediately with relevant and actionable intelligence. Accurate and timely (leading) data that is brought in through the internal data management processes yields good data output, insights, predictions, and quality efforts/outcomes. Alternatively, outdated or stale (lagging) data yields poor output, insights, etc.
Payers, providers, and employers often use claims data as the primary data source in identifying risk and tracking chronic disease trends for their population health management programs. Unfortunately, the data provided by the claims is a lagging data source that only tells the story of historical illness, contrasted with current and relevant leading data sources which help to identify risk earlier, allowing the opportunity for a better and timelier outcome. The lagging data from claims may inform a need for diabetes education for a whole population based on last year’s total spend related to diabetes claims. Contrast that with a leading data set that identifies the actual need for diabetes education is only among a subset of the entire population; 45-60 females at the Nashville location, for example. In this case, the more cost-effective approach to population health management involves utilizing resources for that specific group of people rather than providing education to the whole company that may not suffer from the identified condition. Leading data better informs population health initiatives than lagging data.
If the current year’s initiatives are based on last year’s claims data, the highest need MIGHT be represented, but it might be data from last year’s need. Using cohort information and a leading data set like a health assessment to identify the CURRENT needs and program to support those needs yields better decision making and higher ROI on population health efforts.
The pitfalls of using lagging data:
- Accurate employee risk is not identified correctly upon new member enrollment
- Historical spend does NOT equal predictive risk
- Delayed risk stratification and outreach for DM/CM efforts
- Missed engagement opportunities with members
Delayed risk stratification can cause missed engagement opportunities with members, which impacts the goal of identifying risk indicators before the member moves to a higher risk category. According to SHRM, “Self-reported data from the health assessment sometimes is more timely than claims data and allows for immediate follow-up and engagement in health-promoting programs.”
The most easily accessible leading data set: Health Assessment Responses.
For years, health assessments have evolved to become a valuable source for capturing leading health data. Health assessment is known by many names, HRA, HA, Health Assessment, Health Appraisal, Health Risk Assessment. A health assessment is a screening tool that helps individuals identify and understand their health risks and monitor their health status over time. At PDHI, we conduct Health Risk Assessments (HRAs) that include a questionnaire and personalized feedback about actions that can be taken to reduce future risks, maintain health, and prevent disease.
Best Practices for collecting HRA data:
- Portal access, Single sign-on (SSO) from the member portal
- Paper versions as an alternative option for those unable to access the digital version
- Incentives to help complete the HRA
- Member outreach via live agent completion support services related to the completion of the HRA
- Access to the HRA for health navigator to help complete on behalf of the member such as brokers, or care teams
- Alternative tools and services to facilitate support for those with disabilities
Health plans rely on industry gold standard accreditations and certifications like HITRUST and National Committee for Quality Assurance (NCQA) as mile markers that they’re on the right road. This year, PDHI will be going through our 8th year of NCQA certification and 3rd year of HITRUST certification. Using a data source with this high-level certification ensures that the data is providing the highest quality actionable insights.
Why HRA…why does it matter? Is it worth the effort?
Members rely on their plan to support their health initiatives; the ROI is hard to track but the impact is enormous for claims caught and avoided. Data captured from the HRA allows health plans to be proactive rather than reactive regarding patient care. Using leading data vs lagging data enables you to deploy data-driven plans of action that considers the person, as well as the socioeconomic factors. The benefit involves financial efficiencies for the plan as well as health equity for the member. Leading data will allow you to accurately understand the whole person and identify the best resources to address the health needs of the population.
PDHI is a technology services organization that develops and distributes the ConXus Platform for delivering Population Health Management Programs. ConXus enriches the member experience and meets accreditation requirements with NCQA-certified health improvement tools and health appraisals. To learn more about how PDHI’s Health Assessments can provide your Population Health Management Program with leading data during member enrollment, check out our solutions for Health Plans.