Use Case 15: De-identified claims analytics for selecting physicians

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Requirements

Use case summary

Description

Need a claims dataset at patient level in order to perform utilization analytics and assess physician quality. Examples of quality might include readmissions and misdiagnosis. It would be used to steer patients toward better quality physicians. Reward good physicians with better reputation and more patients. This would be a good complement to the cost utilization data released by CMS in 2014.


Value

  • Value to customer: Our network reaches over 50mm+ patients per month, and we’d love to share cost and quality data with them. We haven’t used the utilization dataset yet, however, because of the need for “quality” related info before sharing.
  • Value to industry/public: This would obviously be pertinent to provider groups, payers, self insured employers, and social workers who help underserved populations choose care.


Customer

Publishes quality metrics and reviews on doctors for use by patients. Also provides useful contact and background information.


Current data and limitation

Patient level claims aren't currently available for such analysis


Specifications

  • each claim, de-identified but still individual-trackable

Solution

Short term workaround

  • ___

Long term implementation

  • ___