Claims databases help docs boost quality, lower costs, paper argues

A paper in the most recent issue of Healthcare argues that claims databases in California and Wisconsin have allowed providers in those states to improve quality while lessening costs. The authors, led by Dr. John Toussaint of the ThedaCare Center for Healthcare Value, believe that the databases allow doctors to compare themselves to their peers and thereby improve quality.

The paper spotlights two data organizations in each state, and describes how they aggregate claims data, lab information, medication lists and other information. For some of the data warehouses, such as the Wisconsin Collaborative for Healthcare Quality, the resulting data is published in annual reports and allows for custom reporting, meaning that providers can see how they compare in a timely fashion.

That allows interested providers to stay informed. One provider—the Ministry Medical Group—displays information on 30-day readmission rates and emergency room visits, and ties in about 15% of their nonrevenue value units bonus based on some of the metrics provided by the data warehousing organization.

Data also can be used for examining population health. One coalition examined Wisconsin's data concerning treatment of patients with bipolar disorder and found that primary-care physicians avoid antidepressant monotherapy, a non-recommended treatment in 85% of cases. The goal, then, was to communicate those results and especially try to close a gap with psychiatrists, who avoided that treatment course in 93.3% of cases.

The use of value reporting also can be seen with Toussaint's ThedaCare, which has been visualizing diabetes indicators and comparing its physicians' performance.

In the future, while the paper argues that “significant breakthroughs … in the science of performance measurement” are on the horizon, it also notes that the critical factor is to develop more collaboration—and to release those metrics publicly, so that patients can use the data as well as providers.

Follow Darius Tahir on Twitter: @dariustahir