Clinical data a must for managing patient risk

Carl JohnsonIn the new health care economy, we counsel providers seeking to strengthen their position should utilize a comprehensive data set. But too often, health care providers are limited in the data they use. Medicare claims data are their traditional source of data, and it’s often used as their main source of health care intelligence.

It’s becoming clear, however, that those providers who can leverage large data sets of both clinical and claims data will see better results for their patients and stronger financial stability.

The benefits of including clinical data as you manage patient risk are many. First and foremost, clinical data is almost always available within 48 hours. Compare that with claims data, which is usually at least 60 days old, and it’s easy to see that clinical data can give you much more actionable information:

  • Patterns and risk factors can be more easily identified by examining properly coded electronic clinical reports, especially when multiple providers are involved. This will improve long-term outcomes for patients and reduce more costly procedures in the future.
  • Clinical data will show services that may not be included in the claim, such as educational information provided by a physician, health care coaching or care coordination.
  • Improvements in the health of a patient can be better identified by clinical data, especially those outcomes driven by physician recommendations.
  • More detailed information can be gleaned from clinical data, even if the procedures are identified by claims data. Take, for example, a diabetic patient. Claims data would show an insulin prescription, but clinical data could identify additional risk factors based on lab results, vital signs and other contributing health factors based on socio-demographic data.
  • Patterns and risk factors can be more easily identified by examining properly coded electronic clinical data, especially when multiple providers are involved. This will improve long-term outcomes for patients and reduce more costly procedures in the future.

Clinical data isn’t perfect, though, and I’m not recommending you ignore the benefits of claims data. In my next blog post, I’ll discuss how to make the most of claims data.

For a full report on the benefits of combining clinical and claims data, read the latest Optum featured topic: The importance of clinical and claims data.

–Carl Johnson, MD, EdM, MSc.

About the Author:

Carl Johnson, MD, EdM, MSc. is a pediatrician trained at Boston Children’s Hospital. He completed a Medical Education fellowship at Harvard Medical School and was a faculty health services researcher at The Mount Sinai School of Medicine.

Before joining Optum Analytics he worked as a physician executive at Cerner Corporation. He is a graduate of the Mount Sinai School of Medicine in New York City and has held faculty positions at Harvard Medical School, University of California at San Francisco, The Ohio State University, and The Mount Sinai School of Medicine.

Dr. Johnson believes that healthcare can be transformed with the help of the right data. When he is not helping to transform healthcare, he can be found playing tennis, cooking, perfecting his French, taking photographs, reading historical fiction, listening to music, and watching Ohio State Football.

One thought on “Clinical data a must for managing patient risk

  1. Pingback: Making the most of health care claims data in value-based care | Health Care Conversation

Leave a Comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s