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The Role of Claims Data in Evolving Telehealth in Healthcare

Understanding Healthcare Market Share Changes in a Value-Based, Patient-Centered Landscape

In a 2017 study published by Health Affairs, commercial claims data on over 300,000 patients from three years (2011-2013) was analyzed to explore patterns of utilization and spending for acute respiratory illnesses.

The study found that while direct-to-consumer telehealth may increase access by making care more available and convenient, it may also increase utilization and healthcare spending.

According to the American Telehealth Association and AANAC Conference telemedicine offers these four primary benefits:

  • Improving Access: Telehealth brings care to patients in remote areas. It expands the reach for providers to offer care beyond their facilities.
  • Cost Efficiencies: Keeps costs down through better chronic disease management, shared healthcare staffing, reduced travel times and fewer/shorter hospital stays.
  • Improved Quality: Telehealth has come a long way and the quality of telehealth care often equals that on in-person care in many situations.
  • Answers Patients’ Need: Consumers like telemedicine, and it provides both access and answers when and where they need them.

Given these goals and the recent Health Affairs study showing telehealth may not actually reduce costs, how can claims data be of value in both improving access and lowering costs through telehealth?

Patient Outreach & Engagement: Claims data can be used to analyze utilization, physician patterns, geographic trends and more. This can be valuable in creating and informing patient outreach and engagement programs to encourage patients to take a more active role in their healthcare, including proper usage of telehealth programs. While patient engagement is still in its beginning stages, early evidence shows it has huge potential to lower the cost burden on the healthcare system.

Support Value-Based Healthcare: Regardless of what happens with healthcare legislation, the train has left the station when it comes to value-based care. Value-based care focuses on managing rising costs, reducing inefficiencies and redundancies in the system and rewarding providers and healthcare systems on quality over quantity. Claims data has great potential to be leveraged to inform when and where telehealth services should be utilized to support value-based care initiatives.

Big Data: Big data must not only include clinical data, but also claims data along with lab and other data to be truly meaningful for strategic decision making. As hospitals and healthcare systems become more and more advanced in data analytics, big data will be better positioned to inform the proper usage of telehealth to both achieve cost savings and improve access to care.

Given the aging population, physician shortages in many areas and the growing need to manage chronic diseases, telehealth has a lasting role to play in healthcare. However, utilizing it effectively to meet the goals for telehealth and the emerging value-based care environment will be critical and data – including claims data – will be needed.

At Intellimed, we offer claims data analytics solutions that can help inform strategic decisions for telehealth as well as many other areas. To learn more about our solutions or to schedule a demo, please contact us.

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