The Alliance for Health Reform www.allhealth.org with support from Anthem presented the briefing “Tools for Patients: Data, Technology, and Communication in Patient-Centered Care” to provide ideas on how data is effectively being used to communicate with health professionals, hospitals, consumers, researchers, government, and public health offices.
Ben Moulton, JD, MPH, Senior Vice President, Advocacy & Policy at the Informed Medical Decisions Foundation www.informedmedicaldecisions.org described how the term Shared Decision Making (SDM) is now a standard part of the language of patient-centered care.
He pointed out that 130 trials addressing 23 different screening or treatment decisions using SDM has led to more accurate risk perceptions, greater comfort with decisions, greater participation and engagement in decision-making, and fewer patients choosing major surgery.
Niall Brennan, Chief Data Officer and Director of the Office of Enterprise Data and Analytics for CMS www.cms.gov emphasized how CMS the largest single payer for healthcare services in the U.S expects to serve over 125 million individuals in 2016 between Medicare and Medicaid/Chip programs. Also, CMS provides new data sources such as the meaningful use of health IT, quality information of value to providers, and health insurance marketplace data.
To promote delivery system transformation, CMS is using advanced analytics and routinely sending near real-time monthly data to facilitate care coordination to ACOs and to State Medicaid programs for Medicare-Medicaid enrollees.
The feeds include information on beneficiaries and their entire claims history, for all service types, procedures, and supplies. The data gives the private sector an opportunity to help transform the data to clinical information.
In June 2015, CMS posted the third annual release of the Medicare hospital utilization and payment data. Brennan reports that CMS will continue to release the hospital and physician data on an annual basis.
According to Robin Gelburd President of FAIR Health www.fairhealth.org, the organization’s national database of billions of healthcare claims is very useful to consumers. The data supports consumer decisions by offering management and operational support, provides data on fee schedules and reimbursement, engages consumers in public health, and provides policy and research information.
Specifically, consumers can use the FAIR Health web site to find out how much they will pay for a service not covered by insurance, amount to negotiate with the provider, determine how much insurance will impact costs should they stay in network, and how much will they likely pay if they go out of network.
The crown jewel of FAIR Health is the development of their Consumer Engagement Platform. For example, the “FH Medical Cost Lookup” provides estimated costs for medical procedures and equipment, bundles related procedures, compares reimbursement methods, and provides flexible sliders to customize results.
Representing Anthem www.antheminc.com, Tim Skeen, Vice President of Marketplace Solutions, Information Technology Division, commented that Anthem’s main goal is to focus and empower the consumer with data so that the consumer experience is good.
This is accomplished by instilling confidence in consumers, helping consumers understand costs and benefits to avoid surprises, and by providing help when needed that requires interaction with your insurer only when the need arises.