Our Take on Value-Based Member Merging
In the past, resolving patient duplicates in the EMR was as simple as marking for merge and letting the HIM department do their thing. Easy Peasy. However, as our new healthcare delivery models have required integration of systems to manage patient health across the care continuum, things have gotten a bit more…COMPLEX. That complexity begins when multiple systems’ source data, used for loading members into your care management and analytics platform, doesn’t match for the same individual. It culminates with the concept that the data loaded is sacrosanct: it cannot be altered because most upstream entities (at this stage in the VBHC journey, anway) take a ‘mine’ mentality towards the data.
At Downshift, we know it’s about the patient and THEIR data, first and foremost. We’re sensible too; we understand why transitioning away from a ‘mine’ model can be a challenge for organizations who are used to traditional healthcare paradigms. We help organizations like you – payer, provider, CBO – to allow everyone to have their cake and eat it too. That is to say, at least until the technology catches up to the needs and everyone can sit down to the celebratory table that will be value-based healthcare paradigms, to SHARE the cake!
Legacy Healthcare
In the legacy healthcare paradigm you couldn’t have more than one address at the patient and/or coverage levels. Either the technology wasn’t there (literally or programmatically) or the players involved in patient management were just far fewer in total. Questions like “Where does correspondence get sent from the hospital?” & “Where do bills get mailed from insurance companies?”, were more simply answered. And ramifications of getting things wrong didn’t exist.
A New Age in Healthcare
Nowadays in HIT, to keep pace with NCQA outreach, interoperability and a medley of other requirements, specific (often disparate) sets of demographics take precedence in a one patient one record system depending on who is working with the member. How can policies and procedures handle such a circumstance? It’s tough, particularly given that even the most advanced EMR in the world hasn’t caught up to the new demographics needs the paradigm is introducing. And two primary components don’t complicate matters any less:
Partnering organizations who provide data on the front end expect it to be the same on return. Naturally.
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Organizations are starting to see that the hardest to reach patients are no longer falling through the cracks. And with that come less static demographics, for a variety of understandable reasons.
While it is true these scenarios do not warrant a duplicate record in a multimillion-dollar platform intended to improve and drive care from analytics. They do highlight the need for innovation in what was once a relatively straight-forward HIT workflow area.
Navigating the Challenges Proactively
At Downshift, we help organizations understand the change in member merging approaches in the context of the change in healthcare delivery models we’re experiencing. We work with providers and payers to carry out the due diligence and execution required to:
Understand current solution flexibility, configure for its shortfalls and work with vendors to get to “more mature”
Configure systems for seamless incorporation of historical and/or service line data into workflows for review and use
Capture, document, and share the policies for each of the dozens of scenarios that will be encountered
Re-capture and re-integrate newly acquired data in such a way that it informs merging processes and policies
Create intuitive in-system tool-sets to mark and merge members in a way that all stakeholders can get behind
Get Out in Front
Having your end-users saying ‘easy peasy’ when it comes to value-based member merging workflows is not unfeasible, even as we await technology to catch up. In the context of getting things right for your highest risk populations, the first time, innovation cannot be delayed. Demonstrate to your partners and patients that you’re ahead of the curve with regards to managing data in a patient engagement, consumerism-driven healthcare world. Downshift, hug the curves, and set the pace.
