From ThinkAnthem.com

INTEGRATING CLAIMS AND CLINICAL DATA TO SUPPORT A PERSON’S WHOLE HEALTH

AUGUST 29, 2019

Advancing Quality | Driving Affordability and Access

It’s well-known that healthcare providers collect clinical data throughout the course of a patient’s care experience and payers collect claims data for a patient across their medical, pharmacy and dental benefits. But clinical records rich with information don’t always make it to the claim record, inhibiting our ability to understand consumers’ personalized care needs.

By combining these fragmented data streams, we can empower providers with claims data that gives them a comprehensive health profile for each consumer and allows them to deliver more informed care. More than ever before, we are seeing major forces in the market drive this data sharing to give new dimension to our information.

Anthem Blue Cross and Manifest MedEx Integrate Claims and Clinical Data  

Across the country, Health Information Exchange (HIE) organizations are embracing technology to bring together clinical and claims data to tell a more complete health story for each consumer. According to new survey data from the Strategic Health Information Exchange Collaborative, more than 9 in 10 Americans are served by an HIE.

In California, Manifest MedEx (MX) is the largest nonprofit HIE network, managing patient records in a private and secure way for over 17 million people. MX currently collaborates with six leading health plans across California and more than 400 participating organizations, and those numbers are quickly growing.

Anthem and MX recently took a major step forward, making claims data from Blue Shield of California and Anthem Blue Cross directly available alongside clinical data in MX’s longitudinal patient records. We are working together to empower providers to improve patient experience, close gaps and deliver more informed care.

The Benefits of Integrated Claims and Clinical Data

When providers can quickly and easily see all clinical and claims data, they know every doctor a patient has visited, what treatments or diagnoses they have been given from other providers and their vital signs history. Do they have allergies? What medications are they taking? Are they diabetic? When providers can securely exchange data, they can answer these questions to create a more holistic view of the patient and better provide whole person care.

Individuals with multiple conditions can especially benefit from integrated data sharing. When providers know all of the health problems their patients suffer from, they can tailor treatments and ensure patients won’t have dangerous drug interactions. Integrated data also allows providers to look at the health of a specific patient population, such as those with diabetes, and develop treatment approaches that lead to better health outcomes.

Clinical data also holds powerful information about a person’s social determinants of health that doesn’t make its way into a claim, such as demographics and medical history. These factors play a critical role in helping providers understand the root issues that are impacting a person’s health and wellness, but without data sharing, it’s difficult to identify and address them.

Anthem currently uses the aggregate, high-quality clinical data from over 7.6 million members to close gaps in care, provide more personalized solutions that support the health of the whole person and eliminate fraud, waste and abuse in the healthcare system. We receive clinical updates in near real time—over 100,000 per day—from partners nationally that enable us to streamline care.

The Importance of Data Privacy and Security

Above all else, as payers and providers make this data more readily available, it is vitally important that we ensure data is shared securely and privately. Those who participate in the MX program sign an extensive contract that specifies how the data can and cannot be used. In large provider health systems, data integration happens seamlessly through electronic medical record systems, while smaller practices not affiliated with a major health system can look up this data on an online portal.

MX also uses multi-factor authentication to ensure data security and has obtained HITRUST Certification, the gold standard for health data compliance and risk management. Anthem is proud to be a member of the HITRUST Executive Council.

Integrated data sharing is at the forefront of the digital transformations we are seeing across the healthcare industry. By bringing data from different points of the healthcare system together, we are helping providers and health plans deliver personalized, effective care.