Lowering healthcare costs while increasing the quality of care depends on the open and timely flow of clinical and administrative data. When payers and providers use this data to inform workflows, providers can deliver better care at lower costs — thereby increasing value for patients.
Pulse8 is an Annapolis, Maryland-based healthcare analytics and technology company that delivers an unprecedented view into risk adjustment, enabling health plans to achieve the highest financial impact in the ACA Commercial Health Exchanges, Medicare Advantage, Medicaid, and Medicare markets. Their mission? To reimagine data to help people live healthy and independent lives through the execution of sophisticated analytics, predictive techniques, and data collection tools.
Pulse8’s cornerstone platform is called Illumin8. Illumin8 is designed to remove waste, optimize revenue, and deliver innovation within the workflow of a health plan or at-risk provider. The visualization and reporting platform allows risk-bearing entities — health plans and providers with ACA, Medicare Advantage, and Medicaid patients — to address risk adjustment and quality metrics for all government programs through the power of big data, risk adjustment and quality metrics. Pulse8 achieves this by pulling in data from its payer customers and comparing it against algorithms in its Illumin8 platform, and then providing reports back to the customers to help them with risk adjustment and coding.
Pulse8 has identified a need to bring in data directly from their provider partners’ EMR systems. Dealing with the volume and complexity of data derived from EMRs is no small challenge, though.
“Some of our customers would like to get out of the business of pulling in their own data and aggregating it because it’s a lot of overhead,” said Jason Setters, Pulse8 EMR Integration Engineer. For instance, some of Pulse8’s customers wanted to be able to send Consolidated Clinical Document Architecture files (C-CDAs), a structured data format for patient charts, from their provider partners’ EMR systems directly to Pulse8. By matching patient data between the payer and provider, Pulse8 could then provide their payer customers more robust data analytics.
C-CDA documents contain volumes of rich data, but “they’re big, gnarly XML documents that can be thousands of lines long,” Setters said. In addition, the diversity of data formats from EMRs presented a challenge. “There’s a lot of HL7 v2.x, but then there are other standards, like FHIR and CDAs,” Setters explained.
Download the Case Study to learn how Pulse8 approached the challenge and the steps they took to implement the solution.