REAL Clinical Data To Improve Health Plan Performance

  • December 13, 2019
  • 1:00 PM – 2:00 PM ET
  • online

Many health plans have not implemented true clinical data sources at the enterprise level. While some data can be used in operations from claims/encounters, plans that integrate clinical data from other data streams such as EHRs, HIEs, and clinical labs have been able to leverage this data asset across the organization to improve patient care with enhanced care plans, reduce chart chase and optimize intervention windows for serious health events. Moreover, as part of the new CMS proposed Interoperability rules, health plans need to start down this path to be ready once the rule becomes final since the timeline may be as early as 2020.

In the webinar, the presenters will describe how health plans can develop an enterprise wide clinical data strategy to support important use cases to drive ROI and business value. The presentation will also explore customer case studies to highlight how other payers have benefited from implementing a similar strategy.

Attendees will learn:

  • Become familiar with the key differences between true clinical data sources and limited claims-based clinical representations (diagnosis/procedure code on claims/ encounters)
  • Understand typical approaches to integrating clinical data at the health plan enterprise level
  • Learn the top 3 adverse events that can be consistently predicted 30 days ahead of time and prevented using clinical data helping to improve HEDIS scores
  • Understand upcoming health plan requirements related to information sharing under the new CMS Interoperability Rule
  • Become familiar with ways to enhance or streamline core processes with clinical data, specifically prior authorization, care plan management and predicting adverse events to improve intervention window


Clay Farris
Practice Lead, Client Solutions
Mostly Medicaid

Clay has advised CMS administrators, state Medicaid Directors, health plan CEOs, technology COOs and a wide range of other clients in the healthcare industry. His unique blend of management consulting, project management, policy making and analytics help deliver on-time, actionable results for a wide array of business challenges. His Weekly Medicaid Roundup is read and loved by more than 10,000 professionals in the Medicaid industry. His experience includes policy making at both the federal (CMS) and state levels (State of Georgia), management consulting for large organizational change initiatives, big data solution sales and implementation and cutting-edge analytics. He currently leads key project components related to consultation design, Medicaid subject matter expertise and project management. He has a Master’s degree in Health Policy from the Johns Hopkins Bloomberg of School of Public Health and is also a Certified Internal Auditor.

Lynda Rowe
Sr. Advisor, Value Based Markets

Ms. Rowe is Senior Advisor for Value-Based Markets at InterSystems and for two decades has held senior-level positions in health information technology. Prior to InterSystems she was an executive in the health market at Booz Allen Hamilton, where she led a number of consulting projects for the Centers for Medicare and Medicaid and the Office of the National Coordinator within HHS. She provided leadership for quality measurement, health information technology use and adoption, health information exchange, interoperability and standards, and meaningful use engagements. She spent a number of years running the analytics department for Managed Medicaid plans in Massachusetts. She is currently Chairman of the Board of Directors at Family Health Center in Worcester. Ms. Rowe continues to focus on the advancement of interoperability, technology use and adoption and government policy related to value based care through various workgroups and task forces.

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