Data for Better Health Outcomes

Getting a Better Picture of Members for Better Health Outcomes

Today, healthcare organizations are using data to help deliver informed healthcare. Payers understand that using data can better the lives of their members. If anything, highly precise numbers and accurate data can lead to more tailored education, greater engagement and improved health outcomes for your members. 

So how do you move from a pretty good idea of what your members want to more precise, tailored insight that engages them in their own preventive care and well-being?  

One way is through comprehensive data that provides a more complete picture of each member and makes the numbers easier to understand. Beyond a diagnosis on a claim, what is a member’s financial situation, where do they live and what factors play into their engagement in healthcare services? Do they face economic or transportation challenges? This holistic approach – seeing the whole person – by using SDOH data can lead to health benefits for your members and improve the financial health of your organization.  

Current data such as medical claim and billing history not only gives a limited picture of a member, but it can also be inconsistent or nonexistent. Data is very limited about members who don’t engage with the health system or take advantage of their plan wellness or health risk assessment benefits. Partnering with a data company can help, bringing social determinants of health, financial and geographic data to the table for those members where you have very limited information. 

If you’re like many payers, an ongoing challenge is staying current on each member’s contact information, including address and phone number. It’s not always easy to stay up to date on member whereabouts, especially when you’re busy focusing on optimizing their healthcare. It’s a lot to keep track of – US Census Bureau data shows that 28.1 million Americans moved in 2022.¹ A continuously updated look at member contact information is another benefit of partnering with a data company.  

Reaching members with the right message can reap multiple benefits. Engaging members means getting them actively involved in their own healthcare. The LexisNexis® Risk Solutions e-book “Plans Improve Member Care With Better Data” outlines the case of a man named ‘Dave’ who presents with complaints of joint pain. His provider notices he’s gained weight lately, which could be adding to his pain severity. The doctor notes in the health record that Dave is at risk for obesity and the many adverse health outcomes associated with it.  

But what if the right data source could flag a risk for obesity based on a member’s location within a ‘food desert’ or ‘food swamp’? Armed with this kind of comprehensive data, you could reach out to the member with preventive education tailored to their unique situation.  

And it’s imperative to reach out. Research shows that uptake of preventive services is low,² indicating a need to raise awareness of available options to your members. Also, it’s generally accepted that addressing a member’s health before disease occurs – or while it’s in an early stage – is easier and less expensive than treating them when they have more advanced disease. One study found that only 8% of US adults 35 years and older received all the preventive services recommended to them.³ 

Whole person data, including SDOH data and other relevant information, can paint a clearer picture of a member even when they’re not engaged in their healthcare. These and other members may not have much of a medical claim history, making other comprehensive data about them particularly essential.  

For additional insight, download the LexisNexis® Risk Solutions e-book “Plans Improve Member Care With Better Data.”  

References  

1. https://www.census.gov/data/tables/2022/demo/geographic-mobility/cps-2022.html 
2. https://www.cdc.gov/pcd/issues/2019/18_0625.htm 
3. https://pubmed.ncbi.nlm.nih.gov/29863918/