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Related Experiment Videos

Informatics in managed care: HIM adds value to data.

S D Stratton1

  • 1Pfizer Pharmaceutical Group, NY, USA. strattd@pfizer.com

Journal of AHIMA
|February 17, 2005
PubMed
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Health Informatics (HIM) professionals are crucial for transforming data into valuable information in managed care. Their expertise in coding and grouping systems ensures data integrity for contract pricing, claims processing, and reporting.

Area of Science:

  • Health Information Management (HIM)
  • Informatics
  • Managed Care

Background:

  • Managed care organizations increasingly rely on data for strategic decision-making.
  • The previous article in the series addressed data acquisition and management.
  • This installment explores the role of informatics in adding value to data within managed care.

Purpose of the Study:

  • To define the intersection of informatics and managed care.
  • To elucidate the critical role of HIM professionals in this domain.
  • To demonstrate how informatics transforms data into actionable information for managed care.

Main Methods:

  • Focuses on the application of informatics principles within the managed care setting.
  • Highlights the expertise of HIM professionals in data interpretation and utilization.

Related Experiment Videos

  • Discusses the use of value-added data for contract evaluation, claims processing, and reporting.

    • Main Results:

    • HIM professionals' understanding of coding (ICD-9-CM, CPT) and grouping systems (DRGs, APCs, ETGs) is vital.
    • Informatics enables the transformation of raw data into valuable information for managed care operations.
    • Value-added data supports contract pricing, benefit plan design, and performance reporting.

    Conclusions:

    • HIM professionals are essential for leveraging informatics in managed care.
    • Effective use of informatics enhances the value and utility of health data.
    • This integration supports informed decision-making and operational efficiency in managed care organizations.