Physician Data Analytics – Value of Claims Data

By Richard Howe, PhD, Executive Director of NTREC
Last month I discussed how your electronic health record (EHR) and analytics tools could impact the long-term revenue of your practice and why you should consider getting into data analytics. This month I would like to review how just using claims data can have a positive impact on your practice.

Data Analytics – Where do I start?
The literature on data analytics in healthcare has very divergent opinions on where to start and how much data to collect. Some articles promote collecting all types of information, including medical claims, pharmacy claims, clinical data from EHRs, lab data, personal health record (PHR) data, continuity of care document (CCD) data, consumer reported health risk data, lifestyle and behavioral data (“Integrating claims and clinical data to improve population health,” in Healthcare IT News, March 3, 2015). Obviously, one could do very sophisticated analytics with that data, but collection of all that information is just not practical for the average physician office. So, where do I start?

1. First, get top senior physician leadership of your practice to totally “buy into” data analytics (“A beginners guide to data analytics,” in Healthcare IT News, June 2, 2015). There is no “free lunch” in the initial setup and collection of data – so you must plan for some initial “up front” costs. The return on investment (ROI) may be 1-2 years down the road, so this will require full senior leadership support in your practice.

2. Second, decide who in your organization is going to have overall responsibility for the data analytics system. Make sure you pick a person or small team that understands and can communicate the true clinical and business value to your practice.

3. Start SIMPLE. One of the easiest ways to begin is to use your existing 835 and 837 claims data. It is a consistent set of data that can be used for retrospective analysis. By doing retrospective analysis on a regular basis, you can obtain information and insight on how to improve your practice. For example, you can examine general clinical practices across all members of the care team and see if there are any inconsistencies. This will allow your team to discuss any differences and to collectively figure out the “best practices” for particular procedures and/or types of patients.

4. Know the strategic goals of your practice and then develop a future “weighted data wish list” to support these goals. As you become more comfortable with using claims data, you can then begin to add clinical data – again based on your data wish list.

What are the benefits?
There are many benefits of starting your analytics journey with claims data. These include:
1. Claims data already exists.
2. Requires no new data extracts and/or programming to get the data.
3. Requires no workflow or operational changes.
4. Can obtain patient level specific data by diagnosis and procedures.
5. Can get summarized practice specific data related to diagnosis, procedures, high cost patient populations, revenue by care giver, etc.
6. Can use the summarized data to improve practice patterns, reduce operational costs, and overall improve revenue of your practice.

This is a win-win-win for your patients, your team and your practice!