Integrating Data for Better Care Management

AMCP Partnership Forum: Managing Total Cost of Care Through Medical and Pharmacy Data Integration

Data about your health experiences is everywhere. Smart watches track your heart rate, wellness apps track your diet and exercise, and web-based patient portals provide tidy summaries of your doctor visits and lab results. All of this data is available to your clinician at the click of a button, ready to translate into better outcomes for you and lower costs for the health care system, right?

In health care today, the answer is “not yet.”  

Despite the growing abundance and variety of patient data elements and sources, connectivity between data stored within electronic health records and outside of these records in different systems remains elusive. This fragmentation can surprise patients, who often assume data is already being integrated into care – until a visit to a specialist or the emergency room, where they encounter the reality of siloed data and clinical “blind spots.”

To accelerate the ability of care management programs to use data to combat rising health care costs, while ensuring patient access to innovative treatments that can improve outcomes, the National Pharmaceutical Council (NPC) sponsored and participated in a two-day Academy of Managed Care Pharmacy (AMCP) Partnership Forum, “Managing Total Cost of Care Through Medical and Pharmacy Data Integration.”

Forum participants discussed the considerable efforts needed to achieve the goals of improved care delivery, lower health care costs, better patient outcomes and improved business practices that can come with having connected, interoperable health data.

Despite barriers to data integration, stakeholders agreed that health plans have clear business reasons to devote staff and financial resources to develop an integrated approach to health data, in addition to improved patient health. “Value-based approaches to care are front and center in the broader health system shift from volume to value,” said Jennifer Graff, PharmD, NPC’s vice president of comparative effectiveness research. “The success of these innovative models is highly dependent on data to effectively implement better care, avoid unnecessary tests, coordinate care, and provide access to high-value treatments.”

For health plans, collaborative research shows that some approaches to data use and analysis are more routine, such as managing medication use, while other approaches are more sophisticated, such as pulling together different data sources to develop value-based contracting.

As described in a recent Journal of Managed Care and Specialty Pharmacy article about the Forum, coordination across health plan and health system leadership and governance, finance and business functions, health information technology teams, and care delivery teams is required for successful data integration. “Regardless of whether the data is used for routine or more sophisticated purposes, there are still staff, resource, and interoperability challenges for even the most sophisticated health plan or type of data. These challenges are bigger than any individual data champion or any one functional area within health plans, and success will take organization-wide leadership on data initiatives,” said Graff. 

The multi-stakeholder AMCP Forum outlined a roadmap describing the goals, strategies and tactics that can help guide health plans jump start these strategies across four functional areas:

  1. Leadership and Governance
  2. Business and Finance
  3. Health Information Technology and
  4. Care Delivery (Benefits and Care Coordination)

The roadmap includes common challenges and opportunities to ensure accessibility and portability of data to support evidence-based decisions.  “Having this roadmap in hand will help break down stubborn data siloes and lead us on the path to better care coordination, improved health care costs and better patient health,” said Graff.