Show me the data

Like water in the desert, data has become the new currency in health care.  Data availability has become so important that two payors are investing $80 million in a health insurance exchange in California that will include information on more than a quarter of that state’s 38 million residents.

To be set up as a nonprofit, the California Integrated Data Exchange’s initial success will rest on its ability to convince providers to enrich the database with their clinical data sets. What WellPoint and Blue Shield of California bring to the table is their ability to reach across the care continuum and contribute data on a patient from every potential caregiver submitted for a given beneficiary in every care setting.

The data availability drumbeat continued this week when the American Hospital Association sent a letter to Congress asking the country’s largest payor, CMS, to open the vaults and make more of its data available, including 100% of Part B Carrier and Part D prescription drug data.

As the industry shifts toward value based care, new payment models that will accelerate that shift necessitate that providers have a rich mix of claims data, clinical data and utilization data in order to drive costs down and improve quality. That’s at a minimum to start with, and who knows what other data sources will contribute to the mix in the future.

The AHA was right to end its letter on a cautionary note: Protecting patient privacy will be critically important, not just to comply with HIPAA requirements, but to earn the trust and cooperation of patients, who will be able by law to opt out of data sharing.

Key enablers of this transition were the safeguards in the Affordable Care Act that prohibit payors from canceling policies and denying insurance to persons with pre-existing conditions.  We simply would not be where we are today without that.

Patients must, however, understand that without them giving providers access to their health data, this experiment we call healthcare reform is not going to work. We’re all going to have to get accustomed to a little less privacy if data availability is to work its magic.