Health Plan Data Unlocks Population Health Improvements

Rene Letourneau, January 27, 2016

By analyzing claims data, Milwaukee-based Children's Hospital has measurably increased immunization rates and boosted care delivery and outcomes for some of the city's most vulnerable citizens.

By harnessing the data available through its Children's Community Health Plan—Milwaukee-based Children's Hospital is able identify at-risk patients and to roll out and test new models of care delivery to targeted populations.

Owning and operating a health plan is a significant advantage for a health system when it comes to achieving population health goals, says Robert Duncan, executive vice president, community services, at Children's Hospital of Wisconsin.



Robert Duncan

"The real opportunity with the health plan is that it goes beyond what a normal health system can see from a data standpoint. It gives a more detailed picture of members' claims and data than can be seen in an electronic health record. The data is very important," he says.

Identifying Key Patient Subgroups
Children's Community Health Plans' data is used to focus on three important patient groups for population health management: Those who are sick but rarely seek care, those who also seek care from other providers, and those who are not seeking care at all.

For example, Duncan says, patients with chronic health issues who are not receiving regular care, can be located through the claims data and encouraged to seek treatment.

Population Health Really Does Work

"If two years ago, a plan member had a claim that shows they are diabetic and since that time they have not sought care, you can have a situation that from a population health standpoint you need to address. You need to see what is going on there and try to get that person into a preventive care program before they have a major episode," Duncan says.

Likewise, when patients receive care from other providers, health plan data can augment clinical information in the health system's EHR to give a more complete picture of their health status.

"We may have a child in the emergency department with asthma and through the health plan we can see that the child is also getting care at a local retail clinic or has been seen in another hospital's ED. If you just look at the electronic health record, you would see the child has not returned since their ED treatment and assume they must be doing well. The health plan data gives a different story," Duncan says.

Rene Letourneau

Rene Letourneau is a contributing writer at HealthLeaders Media.

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