Apervita, a growth-stage healthcare collaboration startup, and Diameter Health, a provider of software for health information exchanges (HIEs), announced a partnership earlier this week that will speed up data quality measurement for value-based care.
Apervita’s collaboration platform will now incorporate Diameter’s clinical data optimization software to normalize health system data and improve data interoperability. Diameter offers automated, scalable technology to enable real-time transactions, better analytics and improved care outcomes. The alliance between Apervita and Diameter Health will boost the quality of data used to determine the amount of reimbursement in value-based contracts between providers and payers, according to the companies.
Those quality measures get submitted to the Centers for Medicare & Medicaid Services (CMS).
“[Diameter] gets all of the information in an organized structured fashion so that then we can execute the quality measures to provide feedback to health plans and providers on how the providers are performing against the quality measures,” Rick Ratliff, chief commercial officer at Apervita, told Fierce Healthcare.
There has been a push over the last several years to switch from a fee-for-service model to one in which providers get paid based on the value of care. Physicians with high-quality data measurements above a certain threshold could get paid more, Ratliff said.
“If for some reason the cost was much higher and the quality was not what was expected, they might actually get penalized,” Ratliff said.
A quality measurement could include whether a patient’s blood pressure is under control, noted Eric Rosow, CEO and co-founder of Diameter Health.
For a person with diabetes, the criteria could include measurement of blood sugar levels and whether a patient received an eye or foot exam, Ratliff said. If among 1,000 diabetes patients, 500 got a foot exam, the measurement would be 50% for the exam category, he said.
“That diagnosis is captured inside of the electronic medical record. Then you have to know did each one of these steps that were necessary to properly care for a patient with diabetes actually happen,” Ratliff explained. “Each one of those is a quality measure.”
A key challenge in healthcare is to address healthcare data that comes from different sources and formats and is often not compatible.
“There are four million clinicians entering data differently into more than 100 certified EHRs, which store data differently even in instances of the same EHR brand,” Rosow told Fierce Healthcare. “That means the digital data formats and code systems coming out of EHRs vary greatly.”
Diameter is focused on standardizing the various types of clinical data. “Diameter has some advanced capabilities to be able to pull that data in from a wide variety of resources, and then get it into a standard format on the other side,” Rosow said.
Healthcare organizations are also aiming for clean clinical data, which means codes or units of measure could be missing.
“Clean, normalized data is complete and syntactically correct so that computers and humans can ‘process’ them without extraordinary effort or rework,” Rosow said.
Apervita streamlines reimbursement and provides insight on clinical and claims data using a clinical quality language (CQL) cloud platform. The insights help boost clinical workflows and provide the information needed to form value-based contracts.
“The better the quality of care provided, the better the provider’s and payer’s financial results,” Rosow said. “Such agreements are important because they drive the need for improved quality, accurate measurement and clean data.”
In addition to data-quality efforts, Apervita has recently taken critical steps to secure health data. Last year, Apervita introduced an advanced encryption feature to protect health plan and provider data from data breaches. The technology scrambles data as it travels across the internet and only shows the information to a sender and recipient.
The partnership between Apervita and Diameter will lead to more effective healthcare software overall, according to Rosow. “Better data quality improves the effectiveness of all healthcare applications,” Rosow said.