Despite the vast amount of electronic data available to health plans and providers to determine member or patient risk levels, accurate and timely stratification is actually becoming more complex. That’s because more data doesn’t necessarily mean that the information is reliable, normalized or useful for stratifying risk.

Data integrity has become increasingly emphasized at provider and payer organizations. Although, as recently as 2014, nearly two-thirds of healthcare professionals responding to an American Health Information Management Association (AHIMA) survey reported their organizations did not have a comprehensive information governance (IG) strategy, but agreed that having one in place is a critical component in advancing patient care, improving population health and reducing costs.

Building an IG strategy can be time-consuming and many provider organizations and health plans may not know where to begin. Partnering with an experienced advisory firm that offers proven best practices and IT tools can help the organization implement or optimize a much-needed IG strategy to ensure data integrity and identify high-risk members or patients.

Advanced analytics

Ensuring data integrity, however, is only half the battle in accurately stratifying risk. Health plans as well as provider organizations pursuing risk-based payment contracts need to analyze this data with advanced algorithms developed over many years using data from millions of patients and thousands of providers.

These predictive analytic models can help providers and payers identify high-risk members or patients, but they can also accurately determine which members or patients should be contacted first for a clinical intervention before an adverse event occurs that can result in an emergency room visit or hospital admission. Not every member or patient will respond to phone calls with automated messaging. Some outreach may involve personal phone calls from care managers or secure text messages or emails, depending on the member or patient’s preferences.

Regardless of the outreach method, engaging the member or patient with their prescribed care plan is the ultimate goal for both providers and health plans. More accurate risk stratification based on a solid IG strategy and more reliable data and advanced analytics can drastically improve the efficiency of this re-engagement process. To learn more about how to our risk analytics solutions can improve your care quality, click here.

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