Less Than Half of Managed Care Organizations Have Access to EMR Data

Precision AdvisorsPrecision Advisors, a Precision for Medicine Company, announced the findings from its 2015 Digital Trends Study of 145 managed care executives. The study concludes that decision makers are aware of the concepts of big data and predictive analytics, but are not equipped to fully implement them.

The Health Information Technology for Economic and Clinical Health Act (HITECH) offered incentives for healthcare providers to make use of electronic medical records (EMRs) by 2014. While a majority of providers now use EMRs, according to the study, only 46% of managed care organizations (MCOs) have access to EMR data. Underscoring the importance of this data, within 24 months, 73% of MCOs surveyed expect to receive it. Survey respondents cited interoperability challenges as a key barrier to integrating EMR data.

The Digital Trends Study, the only one of its kind in the industry, is more formally known as Digital and Data Trends in the Payer Marketplace. It was developed by Precision Advisors, a company that supports commercial excellence for global pharmaceutical and life sciences clients. The study offers detailed information on annual trends, key insights, and statistical analysis impacting managed care organizations. Interviews were conducted with pharmacy, medical, and quality directors at health plans, integrated delivery networks (IDNs), and pharmacy benefit managers (PBMs).

While EMR data ranks high on managed care’s wish list, lab results, by a small margin, are the most keenly awaited data. MCOs expect that need to be met soon. Twenty-two percent wished for lab data in 2014, and 21% expect to have it by 2016. Respondents also expressed a desire for many data types, including J code usage, hospital discharge, social media, and outcomes data.

Managed Care Is Turning to Predictive Modeling To Gain Clarity, Reduce Costs
As healthcare costs trend higher, MCOs are increasingly using analytics to forecast risks and reduce waste, especially around drug utilization and emergency room (ER) visits. According to the study, only 47% of the respondents surveyed possessed predictive analytics. By 2016, the report shows that number will rise significantly, with 80% planning to use it.

A key focus of organizations with predictive modeling programs has been pinpointing cost drivers like high drug utilization and frequent ER visits. For organizations with these capabilities, 68% emphasize identifying members at risk for high drug utilization. Early identification of members with frequent ER visits ranks second, with 60%. Rounding out the top 3 is nonadherence to medication at 52%.

“Risk, fraud, and costs present some of the largest challenges and, at the same time, some of the greatest opportunities for MCOs,” said Larry Blandford, executive vice president and managing partner, Precision Advisors. “Industries worldwide are shifting to adopt the use of big data and predictive analytics to solve some of their biggest challenges, but the healthcare industry can do so much more with these technologies to improve their own capabilities and the health outcomes of patients.”

About the Survey
A qualitative survey of 145 payer decision makers was fielded between August and October 2014. Respondents included decision makers at MCOs, PBMs, and Integrated Delivery Systems and Networks. A more extensive summary and analysis of the survey findings can be found in the Digital Trends in the Payer Marketplace final report at http://www.precisionforvalue.com/digital-trends-report

About Precision Advisors
Precision Advisors combines unrivaled real-world market experience with thought leadership and industry expertise to provide insight, strategy, and advice to innovative life science companies. Headquartered in Cambridge, Massachusetts, Precision Advisors’ team of expert advisors encompass all areas of the commercialization spectrum including strategy consulting, managed markets, health economics, clinical research, and analytics. To learn more about Precision Advisors visit www.precisionadvisors.com.

About Precision for Medicine
Precision for Medicine is a specialized company providing services and infrastructure to support life sciences companies as they develop new products in the age of precision medicine. Precision brings expertise, technology, and project execution to support innovative, patient-centric solutions from discovery through commercialization. The company is headquartered in Bethesda, MD. Visit www.precisionformedicine.com for more information.