Posted on: April 20, 2020

One of the key reasons for providers to use Hixny has always been the ability to eliminate duplicate efforts and ease information-seeking activities. This is true for clinical information, such as lab results, current medications or discharge summaries, and for the ability to identify patients who require specific tests or procedures, such as colonoscopies, mammograms or immunizations.

Now, as the march toward value-based payment advances, more reporting—and greater accuracy—is needed to help providers pinpoint opportunities like these to more efficiently improve quality.

For example, administrative claims data has long been used to report against quality measures. While this provides a strong retrospective assessment of how a population of patients is progressing relative to accepted standards of care, it is often outdated by the time it reaches providers—which regularly renders it nonactionable. By adding real-time clinical data to the mix, we improve the timeliness of the information and also bolster the validity and accuracy of the reporting.

And, while some organizations are most concerned with adding clinical data to claims, Hixny is working to add claims data to clinical, since we already connect every hospital and the vast majority of primary care providers and specialists in the area. That’s why, now that Price Chopper is submitting claims from its 80-location pharmacy through Hixny, we’ll be able to help the whole healthcare community gain even more insights. Those claims allow us to identify which prescription medications a patient has picked up, reconcile those against what the provider prescribe, and help providers address gaps in medication adherence.

But, what else could we be doing with administrative claims? And, why aren’t others making claims data available?

We’re not the only ones asking that question. Last month, the Centers for Medicare & Medicaid Services (CMS) set forth expectations that health plans will share claims data with one another and with patients so that the information is freed from individual silos. For Hixny to support that endeavor—and to serve as a data aggregator across the community for public health reporting and quality reporting—we need to have that claims data flowing through the health information exchange.

Not only is Hixny the resource best suited to facilitate data aggregation across both claims and clinical information, but we offer unique system efficiency and workflow benefits. For example, if each health plan sends claims-based quality reports about their enrollees to providers in their networks, the effort and costs are duplicated many times over, both on the part of the health plans and on the part of providers who must log on to multiple systems and aggregate their own results. If all of the information is available from all health plans and providers through Hixny, however, then the duplication is not just reduced, but eliminated.

In a value-based world, success will be measured by how efficiently high-quality care is delivered—both clinically and administratively. Having one source for information in the community offers that efficiency for health plans and providers alike. For that efficiency to be realized, though, health plans need to begin sharing administrative claims data with providers through Hixny just as providers are already sharing clinical data with health plans