Using data exchange to improve quality reporting, target outreach, and reduce cost.

Area of Science:

• Health Services Research
• Health Informatics
• Public Health Policy

Background:

• Healthcare quality measurement imposes significant data collection and reporting burdens on providers and payers.
• Disparate data systems and numerous required metrics complicate quality reporting.
• Covered California and Health Net sought to streamline this process for Affordable Care Act beneficiaries.

Purpose of the Study:

• To evaluate a novel data exchange approach using an all-payer claims database (APCD).
• To assess the impact of historical data sharing on cancer screening rates, costs, and efficiency.
• To determine the potential for APCDs to improve healthcare quality and reduce administrative burdens.

Main Methods:

• Utilized Covered California's APCD for data exchange between the health benefits exchange and insurance carrier Health Net.
• Analyzed historical cancer screening data for Health Net enrollees over a 5-year period.
• Compared screening rates, costs, and efficiency before and after historical data integration.

Main Results:

• Improved accuracy of quality measure reporting by up to 14% for breast cancer screening.
• Generated an estimated $640,000 in potential cost savings for Health Net through reduced administrative costs and eliminated duplicative testing.
• Demonstrated enhanced efficiency and accuracy in quality measure reporting.

Conclusions:

• Historical data sharing via APCDs can significantly improve the accuracy of quality measure reporting.
• This innovative data exchange model offers substantial cost savings and operational efficiencies in healthcare.
• The success of the pilot program supports the expansion of APCD utilization for targeted quality improvement and healthcare advancement.