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By Monica E. Oss

After attending the session, Population Health Management For The Complex Consumer Market: How To Utilize Data To Coordinate Services Across The Care Continuum at the 2020 OPEN MINDS Performance Management Institute, I was reminded of the Biblical story of the Tower of Babel. In the story, the result was the wide array of human languages across the globe.

The session, featuring Cathy Lipton, M.D., National Medical Director, Institutional Programs at Optum; Dianne Shaffer, Director of Systems Development at Integrated Services of Kalamazoo; and Sarah Green, Senior Integrated Health Care Specialist of Southwest Michigan Behavioral Health, reminded the audience of the very disparate views of “value” among the stakeholders.

Dr. Lipton opened the session with an overview of the different health and human service system stakeholders’ focus. Payers have a “mega focus” on the “Quadruple Aim.” Health plans are looking for profitability and growth. Hospitals and skilled nursing facilities want consumers and clinical professionals want career satisfaction and stability. Consumers are looking for resolution of their problems and an easy health care system to navigate. Her underlying premise was that the only commonality among these stakeholders is that they define success in terms of clinical outcomes—and even those definitions vary.

This discussion speaks to the challenges of standardizing performance measures in value-based reimbursement contracts. It also highlights the difficulty for provider organization management teams to develop a “value proposition” that speaks to payers, health plans, and consumers simultaneously. “We’re great at delivering services. What we aren’t great at is telling our story of who we serve and putting ourselves at the forefront of being the solution for payers,” said James Stewart, session moderator and Chief Executive Officer of Grafton Integrated Health Network.

Ms. Shaffer and Ms. Green presented a collaborative initiative between Southwest Michigan Behavioral Health, prepaid inpatient health plans (PIHPs) for eight counties, and Integrated Services of Kalamazoo, a community mental health provider organization, to coordinate care for “high needs” seniors in their market. From the start, the primary challenge they faced was obtaining consumer-specific data and then normalizing that data for use in care coordination. Michigan is unique in having a statewide data repository for Medicaid data so that data is available, but the collaborative has not been able to access the rest of the consumer data—including Medicare data. As a result, their care coordination program is missing fundamental information for both risk profiles and ongoing care management.

Recognizing that limitation, the discussion turned to why data sharing is so difficult and what to do about it. The reasons data sharing among stakeholders is difficult are well known. Different stakeholders in the field “speak” different languages, use different electronic health record systems, record different metrics, have little (or no) agreement on incentives and goals, and have a limited understanding of each other’s capabilities.

The question is what to do about the current constraints to data sharing? This is a key strategic issue for any specialty provider organization. My key takeaway is to understand the priority of data needs and master the art of “small data” (see From Big Data To Small Data—From The Ideal To The Possible and Using Data Can Make Care Coordination More Efficient (& Effective). Even if you don’t have “all the data,” executive teams need to identify and prioritize the “highest value” data needed for optimal performance. This is a case where waiting for “the perfect” scenario is the enemy of progress.

For more on managing your data, check out these resources from The OPEN MINDS Industry Library.

  1. Data Makes The Difference: Using Data To Manage Care Coordination & Value-Based Arrangements
  2. Managing A Holistic Approach To Care: Integrating Physical, Behavioral & Social Health Data
  3. Best Practices For Cross-System Youth Collaboration Focus On Data Integration For Coordinated Assessment & Case Management
  4. Data Whiplash
  5. Using Data To Follow The Money & Stay True To The Mission
  6. Don’t Underestimate The Culture Change In Becoming Data Driven
  7. Proving Your Unique Value To Payers: Data Speaks Louder Than Words
  8. Data Exchange Via Mail & Fax? In Today’s Market?
  9. Make Your Data ‘Count’
  10. Are You Cutting Through The Noise?

For more, join me June 3 at The 2020 OPEN MINDS Strategy & Innovation Institute in New Orleans for “Transforming Organizational Performance: Using Data To Find Advantage & Sustainability.”

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