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Do payers share enough data with ACO partners?


May 10, 2013 | By Dina Overland
For FierceHealthPayer

Data sharing is the foundation upon which accountable care organizations can meet their goals of reducing costs and increasing payer-provider collaboration.

But providers are beginning to sound alarms that some payers aren't providing adequate or high-quality claims data, making that information unusable. Without adequate data, providers lack a complete understanding of each patient's healthcare, thereby hindering their ability to coordinate care, reported AIS Health.

Providers in those situations are forced to reconcile their own information with payers' data, double-check payers' claims data to ensure accuracy and develop data-sharing consent forms to ensure they have all the needed information.

For example, Crystal Run Healthcare, a 300-physician practice participating in the Medicare shared savings program ACO, has struggled with inaccurate, incomplete data from potential payer partners, says Scott Hines, M.D., co-chief clinical transformation officer. Oftentimes, the data doesn't include the right doctors for patients or it includes doctors formerly associated with Crystal Run.

To help avoid these data sharing problems, Cynthia Burghard, research director at IDC Health Insight, has said payers and providers must develop more transparent policies and procedures for analyzing business and clinical data, FierceHealthPayer previously reported. "Transparency and consensus particularly on reimbursement and performance measurement will be critical to success," she wrote in a blog post last year.

Cigna, which already has 56 ACOs operating throughout the country, recognizes limitations to the data it's currently providing its ACO partners. For example, even though Cigna's data includes which patients are in the hospital, their diagnoses and when they're going be discharged, "for many patients we actually don't have discharge data real-time--we get informed a day or two later," Dick Salmon, Cigna's national medical officer for performance measurement and improvement, told AIS Health.

And he admits some of Cigna's data contains mistakes, such as showing a diabetic patient didn't receive a necessary test even though they already underwent the test. "Would we prefer that these things didn't exist? Of course," Salmon said.

But Cigna is working to let providers correct any errors in its data so that by next year, the company can take data corrections from providers and fix any mistakes. Cigna also maintains an advisory panel of some of its ACO providers who identify "what they really need" in terms of data, Salmon said.

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