In healthcare, the quality of chase lists and chart-pulls can be the difference between accurate risk scores and reimbursements, or missed care opportunities that significantly reduce HEDIS and Star ratings. And, these lists are only as good as the level of action taken on them.
Chase lists are a critical juncture in the data journey, but are often also the weakest link. Because of poor data quality, data latency, and data delivery, intended actions are rarely taken. We recently heard from one of our large payer customers they get about a 1 percent response rate on chase lists generated for the purposes of more accurate risk adjustment coding. One percent!
And this, by the way, is fairly typical, whether the list is for the purposes of population health management, risk adjustment, chart pull requests, or disease management. The rate at which such lists generate the hoped-for response is rarely better than about 8 percent in our experience.
Breakdowns in the Data Journey
We’ve seen instances in which an action is recommended on patient data that is 12 months old. If that patient is at risk for diabetes and the action recommended is to intervene, waiting 12 months to take an action is too long. It’s already too late.
Why do chase lists in healthcare perform so badly? In our experience, it boils down to four overarching factors that have a domino effect:
These are the breakdowns we want to address at Lumiata, so that ultimately, the lists we generate inspire action and empower healthcare’s workforce.
So, if we are to transform health plans’ data into lists that inspire a response around disease management or population health management or risk adjustment, it’s important the process:
Our previous blog goes through how we transform the data journey for health plans. We want our customers to become experts of their data, not just administrators of it. If we can do that, we believe that the humble chase list–that critical juncture in the data journey–can become an engine that empowers professionals to move the needles that matter the most for care and cost management.
By: Derek Gordon, COO