Session Info:
The typical member management program entails profiling members based on their disease states without taking into account the patient as a whole. Beginning in the Fall of 2013, CareSource started using claims and enrollment data to segment their members into a specific persona, then began services to members based upon the persona in which they were identified. Learn how they build data driven personas and understand the results they’ve seen to date.
Q&A:
1. What does data driven decision-making mean to you?
To me it means that when possible, we eliminate the guess work component of decision-making. There will always be a component to decision making that is not quantitative, but that should be by choice, not because the data isn’t available in a format that can be incorporated into the decision-making process.
2. How do data sets (EHR data, claims data, member feedback, etc.) to inform your business strategy?
As a Medicaid managed care organization, we use claims data extensively to help shape everything from care programs to business strategy. Ongoing, our strategy continues to be to augment the claims data view of our membership with other data sets that can enrich our view of our members, and help us to identify their needs at the earliest possible moment. As one example, we are currently working on a partnership with a state Health Department and a major university that will expand our view beyond claims data to include social/economic data.
3. In general, how difficult is it to get internal buy-in to build out programming that’s based on data?
Actually, at CareSource the difficulty has been to build out the data to support and enhance programs fast enough to keep up with the requests. Senior leadership here has for some time been asking for more data support to build all of their efforts. Having leadership asking for this support goes a long way toward the success of having an organization focus decision making on fact and less on hunches.
4. How do you see your use of data evolving in the upcoming year? Are there new opportunities to use data to create more effective, innovative programming?
There are a number of changes that are coming. The most notable in health care is the provider base moving to electronic medical records. Many of these systems were first stood up just to meet requirements for enhanced reimbursement, but now the effort is to fully incorporate this information in work-flow and use it in a meaningful way. To that end, there are more changes coming that could even eliminate traditional claims as we know them today. It is all part of many exciting developments that will change how we all do business to deliver far more effective and higher quality care.
To hear more from Bob, please join us at Healthcare Data Insights, June 23-25 in Chicago.
Register now and save an additional $100 off the current rate when using the code: XP1902BLOG
