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How Payers Can Leverage Claims & ADT Data

Health plans are responsible for helping members achieve and maintain positive health outcomes while also ensuring that members are receiving cost-effective care. By combining real-time data with robust claims information, health plan case managers are empowered to identify at-risk members, intervene when necessary, and provide additional support to vulnerable individuals.

Getting the Best of Both Worlds: ADT & Claims Data

The first step in creating more effective care management processes is gaining real-time visibility into when and where members are seeking care.

Claims are the go-to source of information for health plans as they provide a vast amount of information. Claims data is relatively well-structured, consistent, and comprehensive. Additionally, population health analytics and health risk assessments provide further information on members. However, it can take weeks to receive and process claims.

Admission, discharge, and transfer (ADT) information can be gathered in real-time—which can help case management staff identify at-risk or high-risk members. By combining claims information with ADT data, health plans end up with a wealth of information that provides a real-time, yet comprehensive view of a member’s movement through the care continuum.

Turning Information Into More Proactive Care Management

Armed with both real-time and longitudinal data, health plans can help coordinate and provide better quality care for members in a more timely manner. By catching red flags like multiple emergency department (ED) visits early on, health plans can connect members to available resources and work to shift a member’s care to a lower-acuity setting.

Being notified in real-time when a member registers at an ED or is admitted to the hospital allows case managers to prioritize follow-up and engage with members who would be less interested in working with health plan staff weeks later, after claims data is received.

Next Steps

Read this white paper to get an in-depth look at how health plans are using care coordination technology to identify members in real-time, improve care management efforts, and decrease the total cost of care.

Brittany Eastman
Content Marketing Specialist