Transforming your Quality operations with clinical data

May 28, 2021 | Resources, Solutions

Astrata’s Quality consulting services can help guide your organization through the strategy development process.

It all begins with data. If you’re a Health Plan on the journey to quality measurement and intervention across your entire population, the first hill you’ll have to climb is aggregating clinical data from your providers to feed your quality analytics machinery. But even before you start looking into your options for vendors and partners, there is something even more important to do.

You need a strategy

And your data aggregation strategy is likely to be very specific to your own organization, reflecting your company’s goals for growth and new lines of business, the distribution of your provider network, your approach to population health, and the new payment models and incentives you can offer. Some of the kinds of questions you want to ask as you prepare your data strategy are these:

  • Will we centralize data for mission critical analytics such as Quality, Risk Adjustment, and Payment Integrity?
  • Will our approach to data aggregation be direct-to-providers, through an intermediary such as a DAV certified Health information exchange, or both?
  • How will we incentivize our providers to engage in our data strategy, since they hold the keys to their EMRs?

In this phase of your Digital Measurement journey, you’ll bring in stakeholders from your business lines, as well as clinical leaders to build a multi-year plan and begin to prioritize your data sources. But to get to where you are going, you’ll need a way to travel. It’s time to start building your roads.

Building the roads

Like most health plans, your goal is to maximize the value of this transformation to your quality ratings and bonus payments. So you’ll need both structured EMR data and unstructured EMR data to get the best boost to your rates. But how will you get this data? The next step of your journey is all about connecting. Making the transition from chart chasing at the end of the year, to a stream of incoming data feeds, is a sea change.

 

  • What data will we need?
  • How many different EMRs will we need data from?
  • What’s the right tempo for incoming data?

Astrata’s data acquisition and engineering services help you aggregate data from across your provider network.

Constellation is Astrata’s state-of-the-art data platform combining a FHIR server and QI-Core with a sophisticated platform for clinical notes as well as rich APIs.

Creating your data oasis

As you bring in more and more EMR data, labs, observations, procedures, and conditions, as well as clinical notes in CCD, text and PDF – the next part of your journey is all about creating the foundation for your HEDIS transformation. A foundation that starts with a clinical data repository (CDR). Your quality data store will need to store data in the right data model so those computable measures to do their thing. But it will also need to store hundreds of millions of clinical notes, so that NLP algorithms can identify the rich quality information that only appears in text. And for both your structured and unstructured data, you’ll want something that you can stack other software on top of – with APIs to your data – so that you store once and use many times.

But you can still do the fun part first

Don’t make the mistake of thinking that you have to do all of these things first before you get to the fun part. With Astrata’s technology and services you can build incrementally, adding data over time, and continuously improving your clinical rates. You’ll be gradually switching your team over to year-round quality, supporting your goals in value-based care. And moving your operations to Digital Quality. That’s the way forward as your organization makes the journey to quality transformation.

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