The Patient Identity Imperative: Getting Started

During my “Patient Identity Imperative” webcast with Verato on July 27, I discussed how the industry is slowly lurching better data governance to manage patient identities. With several drivers at play and differing government metrics and standards, the path to governance is sometimes slow and uneven. But when it comes to improving patient identity data and better protecting patients, we can’t afford to wait for standards to crystalize.

Following the webcast, I was asked several interesting questions that may help you think through and plan your own governance strategy:

What is the biggest industry driver for more accurate, real-time patient identification?  
I have a tough time choosing between population health and the switch to value-based reimbursement. Both aim to demonstrate that better quality care is being delivered in a cost-effective fashion. In both cases, that hinges on delivering a comprehensive view of an individual’s care and data across a complex health and wellness ecosystem

If forced to choose just one, I’ll go with value-based reimbursement, as major financial incentives are helping push this trend. For example, United Health Group is giving 1900 primary care physicians a total of $148M in incentive pay in 2015, and CMS has stated that they want 50% of their 2018 payments made toward value-payments.

Why do you believe the ONC Interoperability metrics will translate beyond the government?
I believe both private insurers and the government will use interoperability metrics as levers for stronger data quality. The move to accountable care organizations (ACOs), where private insurers vastly outnumber government-sponsored ACOs, illustrates how the private sector can adopt and fast-track a concept. Since better patient identification data aids care delivery, data integration, and all the secondary uses of data, it follows that the private sector will “jump on the bandwagon” of the ONC metrics to substantiate patient identity integrity.

Reaching the goal of less than 2% duplicate record rate by 2017 and 0.5% by 2020 is daunting, particularly since less than half the market understands today’s rate. Without this baseline understanding, they can’t even start building a plan and begin corrective action. One can argue that the ONC numbers aren’t reachable and will be modified, but I think a better use of time and resources is to build a plan, quantify accuracy today, and get started rather than quibbling over the goals themselves. Fewer duplicates will benefit everyone, from patients to providers and insurers.

Won’t a national healthcare identifier solve the patient identification challenge?
Patient identity is a complex problem that requires a solution, not just a better identifier. While there appears to be movement to lift the long-standing ban on Health and Human Services (HHS) funding a review of patient identity, it’s very early in the process. Even if HHS were to fund such a review, it could take years to define a solution and allocate funding to actually execute a solution. In the meantime, let’s take some action now!

View the full replay of my webcast to learn more about how healthcare providers, the industry, and the government are approaching the Patient Identity Imperative.