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LexisNexis Assists Hospitals in Predicting Readmissions with Non-clinical Data
Using clinically validated social determinants of health data, new risk score helps predict
30-day readmissions for more efficient care
ATLANTA – (March 1, 2018) – LexisNexis Risk Solutions announces the release of its new Socioeconomic Health Score – focused on assistance with predicting hospital readmission risk – at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference and Exhibition, March 5-9 in Las Vegas.
The cutting-edge analytics model leverages hundreds of socioeconomic data attributes derived from public and proprietary records to help predict how likely a patient is to be readmitted to the hospital within 30 days. It can help hospitals improve risk stratification and redirect resources to focus on more effective discharge processes, aftercare counseling about medications or lifestyle choices, and other strategies to prevent medical complications or readmission – optimizing hospital reimbursements and minimizing penalties under current value-based performance programs.
“Healthcare regulations that penalize hospitals for readmission within 30 days of discharge are a major financial impact for care providers,” said Josh Schoeller, senior vice president, LexisNexis Risk Solutions. “In response, our access to and expertise on the application of non-healthcare data for improving outcomes enables us to help hospitals reduce these occurrences, minimize costs and allocate preventive resources more efficiently. This is a win for both hospitals and their patients.”
The Readmission Risk Score is part of a broader suite of socioeconomic solutions that utilize social determinants of health data (SDOH), which, according to the World Health Organization, is data on the “conditions in which people are born, grow, live, work and age” that impact their health. SDOH affect overall health outcomes more than medical determinants, according to County Health Rankings. Research conducted by LexisNexis indicated that the Readmission Risk Score is on par with—or better at predicting risk than—readmission scoring models that use only clinical data, which is often difficult to obtain.
To compete in today’s healthcare market, it is vital that providers improve risk stratification and adapt care management strategies to personalize care for its most at-risk patients. The Centers for Medicare & Medicaid Services (CMS) is making sure of that. Under the Hospital Readmissions Reduction Program (HRRP), CMS withholds up to 3 percent of Medicare reimbursements if hospitals have a higher-than-expected number of readmissions within 30 days of discharge for the following conditions:
Of patients with these ailments, the LexisNexis risk score — which can be loaded into existing systems – helps to identify those at highest risk for readmission.
Also critical is that – under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) - there are quality measures related to readmissions that hospitals may choose to be measured against that would impact their financial reimbursements. Two key measurement areas are All-cause Hospital Readmission and Unplanned Hospital Readmission within 30 Days of Principal Procedure.
To learn more about the LexisNexis Socioeconomic Health Score: Readmission Risk Score and LexisNexis® Socioeconomic Health Attributes, visit booth #3438 at HIMSS18, or read our white paper, Six Myths About Social Determinants of Health.
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About LexisNexis Risk Solutions
At LexisNexis Risk Solutions, we believe in the power of data and advanced analytics for better risk management. With over 40 years of expertise, we are the trusted data analytics provider for organizations seeking actionable insights to manage risks and improve results while upholding the highest standards for security and privacy. Headquartered in metro Atlanta, LexisNexis Risk Solutions serves customers in more than 100 countries and is part of RELX Group plc, a world-leading provider of information and analytics for professional and business customers across industries. For more information, please visit www.lexisnexis.com/risk.
Our health care solutions combine proprietary analytics, science and technology with the industry’s leading sources of provider, member, claims and public records information to improve cost savings, health outcomes, data quality, compliance and exposure to fraud, waste and abuse.
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HIMSS18 on-site contact: Ed Domansky, 843.290.9408 or firstname.lastname@example.org - Media & Analyst Relations, LexisNexis Risk Solutions
To learn more, call 866.396.7703 or visit lexisnexis.com/risk/health-care
Poor quality provider data negatively impacts patient outcomes, operational efficiency and profits.
In 2016 a research group at West Virginia University had a team of “secret shoppers” pose as patients and attempt to make appointments with 743 primary care physicians listed in California health insurance directories. They were unsuccessful 70% of the time.
What they discovered were massive errors in the provider data. Much of the information was incorrect or outdated. Among the obstacles they encountered were physicians no longer with the medical group, incorrect specialties listed, practices not accepting new patients and disconnected phones.
Although this experiment focused only on health insurers, the issue of provider data accuracy is applicable to any healthcare organization. Your business is only as good as the data on which it runs.
Why accuracy matters
Maintaining the dynamic universe of provider date is a difficult but critical task for hospitals and health systems. Provider information fuels many functions of everyday business, including provider directories, claims processing, network management, compliance, fraud detection, physician marketing and recruitment, and communication between healthcare practitioners.
When provider data is accurate, these operations proceed smoothly. When they don’t work as they should, the impact of errors and missing information can be felt throughout the system.
Without proactive management, thorough attentiveness and the right technology, the quality of an organization’s provider information diminishes quickly. The result is operating inefficiencies and sub-optimal networks that cost hospitals and health systems hundreds of thousands, and potentially millions of dollars each year.
Ensuring data integrity
If everyone agrees accurate provider data is a necessity, why aren’t health systems and hospitals doing more to improve their data quality?
Although data degradation plagues the health system, most hospitals don’t realize the prevalence of poor provider information in their own databases. They’re focused on their core business. Handling daily operations and responding to urgent needs take priority. There’s also a belief that collecting provider data is straightforward. In reality, the process can be extremely complicated and time-consuming. To manage and maintain the quality, the data must be routinely cleansed of any errors and continuously updated with information gleaned from thousands of reliable data sources.
Human error, organizational silos and resource limitations all create additional hurdles. So does a lack of industry-wide standards. Hospitals must navigate disparate reporting requirements from their providers, which contributes to inconsistencies and errors.
Physician data must be prioritized
Information collected and maintained on the physician population is of particular importance and requires a consistent, automated process to be kept current. But with so many touchpoints and no centralized place to push updates, the alarming result is that questionable data often fuels critical workstreams.
Assessing the problem
While the collection, management and maintenance of provider information is a specialized area, the people who rely on that information work in a wide variety of capacities throughout an organization. Therefore, the impact of bad provider information is difficult to identify and quantify. Resolving any issues often falls to the back of the priority queue behind traditional strategic initiatives and major IT projects.
Most healthcare systems and hospitals don’t know the answers to basic, yet important, questions such as:
When costs and impacts are dispersed across an organization, getting recognition of the problem and the funding to remedy it can be an uphill battle.
The right solution
Fixing the problem of bad provider information is more complicated than simply purchasing new data from an outside source. Healthcare systems and hospitals must be able to reconcile their existing data. They need a solution that identifies the specific data that should be updated, fills in data gaps and prioritizes the needed changes.
What’s at stake
Accurate provider data is a crucial element for efficient operation, regulation compliance and quality care. It translates into real savings and risk mitigation. With healthcare reform underway, its importance is likely to grow.
Those organizations that take steps now to remedy data issues will be better positioned for long-term success and able to ensure the best possible patient care experience.
For more information, visit us at booth No. 3438.
Edward Domansky, JD
Media & Analyst Relations
LexisNexis Risk Solutions