TrueCare

Jeremy Lutz

Navigating the intricate landscape of healthcare analytics to provide healthcare organizations with actionable insights remains a formidable undertaking for enterprise analytics teams. In this article, Jeremy Lutz, a distinguished EA expert at TrueCare–a nonprofit community-based health center serving San Diego and Riverside Counties–delves into the challenge, noting that designing quality data reports in the dynamic California healthcare environment has even more layers to address.

Amidst diverse standards set by numerous entities, the task at hand is complex–baffling even the seasoned analytics professionals. Foremost, there is the federal Uniform Data System (UDS) standard and the Healthcare Effectiveness Data and Information Set (HEDIS) measures of Medi-Cal (known as Medicaid nationally). Yet, these are just the tip of the iceberg; the ever-evolving ecosystem sees health plans and community health centers working around other different standards as well, further exacerbating a complicated landscape.

Here, Lutz dissects the multifaceted strata inherent in evaluating a data ecosystem. By operating on multiple levels ranging from performance and population health to operational intricacies and provide incentives, TrueCare can focus on patient care and improving health outcomes.

As a Federally Qualified Health Center (FQHC), we are held accountable by the Health Resources & Services Administration (HRSA). Their set of standards are the UDS quality measures. Yet, all Medi-Cal health plans use HEDIS as their quality standard and they are accountable to the California Department of Health Care Services (DHCS) and the California Department of Managed Health Care (DMHC).

One of our biggest challenges is that we are completely reliant on the Medi-Cal health plans to tell us how we’re performing against the HEDIS measures. Unfortunately, we cannot maintain that data ourselves because the software (or internal development time) is too expensive for a nonprofit.

" My advice for senior leaders and customer experience officers working in healthcare would be to find a company you like with a mission you believe in "

Besides cost, having multiple sets of quality measures gets confusing. For example, there are similar measures in UDS and HEDIS, but they aren’t the same rules, which leads to differing scores in measures that would ideally convey the same information. Because these two different ‘languages’ exist, the providers end up being held to two different standards, and that creates confusion and redundant work.

Alignment among the regulators so that everyone is using a common set of measures would be a first step to solving the aforementioned challenges. Agreeing on one set of quality standards would not only help get everyone on the same page and reduce redundant efforts, but would benefit patients and health outcomes, especially in underserved populations.

In the meantime, we do what we can with what we have. The plans send us some HEDIS ‘gap’ files, and we are developing processes to either import that data directly into our EHR or our data warehouse. Getting the data into our EHR would be ideal because it gets the needed information into the application that our providers use the most. But that will be a more complicated process. A simpler solution would be to get the HEDIS gap data into our data warehouse. It would not be as convenient for the providers, but it would still support outreach and analytics efforts. Either way, the goal is to identify patients in need of care and to try and get them that care.

In regard to our day-to-day operations, my goal at TrueCare is for our analytics teams to deliver simple, clear information to senior leaders across the organization. Analytics platforms, like Power BI or Tableau, help us accomplish that goal – but that doesn’t paint the entire picture. We help monitor the efficiency of current processes, identify geographic areas favorable for expansion, and keep everyone in the organization aligned.

C-suite executives are constantly making data-driven decisions. An enterprise analytics team needs to be able to provide metrics via a series of dashboards. At TrueCare, we have roughly one for each business area, which encompasses a large array of protocols – such as reports on user tracking with weekly updates for operations, empanelment, financial, productivity by department, operational reports, quality measures, referrals, and so on. To do that, we experiment with newer technology that allows us to develop a ‘library’ of Known Performance Indicators (KPIs), which senior leaders then use to build their custom dashboards. Achieving that level of access in today’s fast-paced health care environments is not only important for day-to-day operations but especially necessary when responding to a public health emergency.

My advice for senior leaders and customer experience officers working in healthcare would be to find a company you like with a mission you believe in. When your work has a sense of purpose, it keeps you motivated; knowing that I am doing my part to help make a difference in the lives of people in need is rewarding.”