Business Driver

A statewide healthcare plan had several disparate efforts underway to obtain and integrate clinical data from Providers for various uses, including HEDIS/STARS reporting, risk adjustment, claims adjudication, and care management. To unify and improve the processes and technology for obtaining and leveraging this clinical data as effectively as possible (while minimizing the administrative burden on their Provider partners), the Director of Provider Networks asked Trexin to conduct a preliminary assessment of the Payer’s business needs for clinical data, survey the regional and national market for examples of effective clinical data exchange and best practices, and assemble profiles of solution vendors having clinical data exchange products and services.

Approach

First, Trexin conducted in-depth interviews with business and technology stakeholders to better understand their individual needs for clinical data. The findings from these interviews were then summarized and discussed with the Client sponsors. Of particular interest was the revelation that the definition of “clinical data” varied widely across the organization, which prompted further discussions to align on a unified definition.

Trexin then conducted a survey of Provider-Payer clinical data exchange activity, both regionally and nationally. By utilizing the deep subject matter expertise of Trexin’s healthcare consultants and their industry relationships, we established a knowledge base of relevant experiences for our Client to consider as pathfinders. Additionally, unsuccessful examples were catalogued and analyzed for root cause.

Trexin concluded the project by creating a four-phase framework to identify and classify vendors purporting to provide products and services in the Provider-Payer clinical data exchange space. Using this framework, Trexin evaluated over 35 vendors and their solutions, identifying the top candidates for our Client’s needs.

Results

Based on stakeholder input and early-adopter lessons from the market, Trexin helped our Client drive internal consensus that the business case for clinical data exchange should focus on HEDIS/STARS reporting and risk assessment/revenue processes. Trexin also prescribed a series of “next steps” to pursue these initial high-value use cases and identified a number of potential pitfalls to avoid. Trexin also identified eight specific solution vendors that appeared to be best positioned to meet our Client’s future-state clinical data exchange needs. Collectively, these results established the foundation for a more detailed clinical data strategy and investment roadmap.