Health care providers in ideal position to combat data overload (OPINION)

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(Jamie Francis/Staff)

By Richard Katz

Medical providers have felt the increasing administrative burden imposed by an innumerable number and variety of payors. We have shared our concerns with executives of our region's major health plans, but our concerns and solutions have been met either with a lack of understanding or apathy.

The recent guest column from Andy Davidson, Mylia Christensen, Greg Van Pelt and Abby Sears ("Oregon's health care data overload") is a welcome, though latent, acknowledgment of the fact that medical providers are inundated with data collection, managed-care prior authorization and utilization review procedures, compliance reporting and all manner of administrative labor that increases the cost of care and reduces efficiency.

Medical communities exist to serve patients, but are regulated by many private insurers, each trying to monitor and assure quality of care and efficacy of utilization. The most sensible solution is to let medical providers develop the common systems that will serve all payors.

Northwest providers have been working to implement a "value agenda" as espoused by Harvard professors Michael E. Porter and Thomas H. Lee, M.D., in their article "The Strategy That Will Fix Healthcare" (Harvard Business Review, Oct. 2013). Their contention is that medical providers must lead the way. This makes sense, as any community's providers are the hub of care delivery, regardless of reimbursement source. Implicit is that payor solutions create the administrative burden that Davidson, Christensen, Van Pelt and Sears have shared with The Oregonian/OregonLive's readers.

For substantive change, providers should determine the correct quality measures and utilization guidelines and permit the multitude of payors to access common metrics, reports and controls that providers can offer to engage in care management. This approach fosters collaboration rather than providers attempting to meet each health plan's ever-changing rule-making. To continue to permit private health plans and insurers to disparately direct and monitor providers has created the rise in administration costs and hindered performance, limited outcomes and decreased the value of healthcare dollars. To maintain the status quo will only perpetuate the problem.

Medical providers in the Northwest have developed and collected quality and utilization management measures for many years now and facilitated their widespread use through an online platform that connects 350 independent clinics in the Northwest and 2,500 nationally (see careconnections.com) into a common outcome-improvement platform. This online platform was built with payors in mind and features the capability for insurers to log on and access patient clinical metrics for review and care management using standardized processes that employ consistent measures of function and pain for each unique patient.

The triple-aim goals of a better patient experience, improved population health and ultimately more affordable care are not simply the province of any one insurer.  These are entire community goals, and as medical providers we can be the leaders in benefiting the entire insurance community, too.

We hope the payor community will join us in revolutionizing healthcare by following our leadership rather than imposing more administrative burdens on an already overburdened medical community.

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Richard Katz is director of contracting and business development for Therapeutic Associates/CareConnections and is executive director of the Northwest Rehab Alliance.

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