What does claims data tell us about patient experience?

February 28th, 2018 / By Kristine Daynes

I’ve been reading ProvenCare, which describes the Geisinger approach to health care and is filled with mottos such as “achieving extreme patient satisfaction” and “treating patients like family.” One discovery is that Geisinger doesn’t leave frontline workers who engage with patients to deliver satisfaction on their own. Rather, satisfaction is engineered into their processes and policies, supported by managerial commitment, and measured relentlessly.

Surprisingly, I found the Geisinger approach to patient experience consistent in many ways to how 3M measures healthcare value—surprising, because 3M doesn’t use or develop patient satisfaction surveys. Our measures and classification methodologies are predominantly based on administrative or claims data. So how could our measures support patient experience?

Claims data might not tell you the patient’s perspective, but it can tell you several things patients care about and which reflect patient well-being. Supplemented with public data such as census reports, it can be used to design processes and policies for things patients want most:

  • No more medical errors and unnecessary health care
  • Fewer readmissions and complications
  • Better access to primary and preventative care
  • Use of high-value providers (not necessarily the lowest-cost providers)
  • Appropriate care management for patients with chronic conditions
  • Fair prices and lower out-of-pocket expenses
  • Better maintenance of health over time

Claims-based analytics helps Auburn Community Hospital in New York address readmissions among high-volume conditions—an outcome that significantly sways patient satisfaction. Based on opportunities identified by their analyses, Auburn initiated changes to processes ranging from daily rounds to discharge planning to emergency department admissions. The hospital saw significant improvements in readmission rates in the first five months and continues to improve. Patients treated and discharged for COPD, heart failure, pneumonia or other chronic illnesses were more likely to stay home longer, without developing complications such as septicemia. That’s something to make patients happy.

High patient satisfaction results from a culture of empathy supported by a system designed for high quality at low cost. Claims data can’t do much for empathy, but it is still the best source for measuring quality and cost, two things patients most definitely care about.

Kristine Daynes is client engagement leader, Performance Matrix, at 3M Health Information Systems.

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