Claims Data Analytics in Focus at ACHE Conference

April 19, 2018

Claims data analytics can shed light on trends important to strategic decision making and organizational functioning for hospital and healthcare system executives. FAIR Health President Robin Gelburd spoke on this subject to an audience of such leaders in a seminar on March 26 at the 2018 Congress on Healthcare Leadership of the American College of Healthcare Executives (ACHE).

In a presentation entitled, “Putting Claims Data to Work: Using Analytics in an Evolving Healthcare Ecosystem,” Ms. Gelburd demonstrated how claims data analytics can illuminate place of service trends, clinical trends and changing reimbursement models, including value-based payment methodologies.

Discussing the emergence of alternative places of service such as retail clinics, urgent care centers, ambulatory surgery centers (ASCs), telehealth and home healthcare, Ms. Gelburd used claims data to trace the relative rates of growth in utilization in such settings in recent years. To explore the settings further, she applied such factors as urban vs. rural usage, state, age of patients and most common diagnoses and procedures.

Ms. Gelburd then revealed how robust claims data could flag important clinical trends, using diabetes, psoriatic arthritis, Lyme disease, breast and oral cancer, knee and hip procedures and opioid-related diagnoses as illustrative examples. She analyzed these conditions from multiple perspectives, including age, gender, cost, volume, comorbidity, procedure code and state-by-state use of procedures.

To shed light on reimbursement, Ms. Gelburd showed the differences between charge and allowed amounts for common procedures in various places of service, such as offices, retail clinics, urgent care centers and emergency rooms. She compared the 80th percentile charge and allowed values from FH® Benchmarks to Centers for Medicare & Medicaid Services (CMS) values for the same procedures in different locations. Examining value-based reimbursement linked to episodes of care, she explained how FH Episodes of Care Analytics could process three years of an organization’s claims to create risk-adjusted episodes with actionable analytics and how FH Episodes of Care Benchmarks could present national and market-area billed charges and allowed amounts for more than 40 episodes, adjustable for common comorbidities and risk factors. FAIR Health uses the PROMETHEUS Payment® model, licensed by the Altarum Institute, to identify the services that make up each episode.

For more information about the data products FAIR Health offers hospitals and health systems, contact us by email at info@fairhealth.org or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.