Contributor: It’s About Time to Realize the Full Potential of Data in Health Care

The value of accurate, timely data in health care is unquestioned. When aggregated, data from across the health care experience—from claims forms to clinical notes—can provide invaluable insights into population health down to the 9-digit zip code level, bringing greater pricing transparency, supporting research in health care affordability, and informing future patient care management.

Paige Killian, MD

Health care data also provide a critical head start for patient assessment, enabling health plans and providers to compare individual patients or members to a data-informed composite. Consider a new patient with asthma. Decades of data from claims, as well as other clinical data, enable us to see that patient in a larger geographical and socioeconomic context. In other words, that patient’s zip code can offer key social risk insights so we can design a more effective management plan.

The challenge, however, is when the story is incomplete because data are missing. What if a patient’s proximity to their pharmacy prevents them from filling a prescription? We can certainly prompt the pharmacist to identify this, but more time must be available to do so. That extra 1 or 2 minutes allows the pharmacist to identify this barrier to care—yet it’s not enough to simply be aware. Up until recently, there was no clear path to document this information and act on it. Thankfully, the system is finally evolving to help clinicians document social determinants of health and mobilize to appropriately care for the patient. The information now exists in claims and clinical data, allowing resources to be dedicated to mitigating these conditions.

Getting Time Back

Gathering information at the point of care to supplement claims and other data is time-consuming, and face-to-face time with patients is woefully limited. It takes time and training to pursue questions such as: Do you have transportation? What is your prescription plan? Are you taking care of other family members? Recent research published in the Journal of General Internal Medicine concluded that “it would take an infeasible 26.7 hours per day for a primary care physician (PCP) to provide guideline-based care for a 2500-patient panel in 2020.”

The lack of time available to gather health information can exacerbate health disparities. In a perfect world, with unlimited time, we’d carefully gather more detailed race and ethnicity details that could eventually improve a person’s care and outcomes. As evidence the world isn’t perfect, however, a recent HHS report shows that Medicare enrollment race and ethnicity data are less accurate for some groups, concluding that this will “limit the ability to assess health disparities.”

Starting at the Top: Addressing Prior Authorization

How do we give our health care professionals the time they need to deliver the best care? While we’re already supporting clinicians and teams by providing them with data-driven insights that streamline both clinical and administrative decision-making, the administrative burden hasn’t eased enough. So, we must look elsewhere to support overburdened clinical staff and their administrative teams. One area of considerable focus is prior authorization, a widely used cost-saving effort that has had an unintended negative impact on patient care and outcomes.

According to the American Medical Association, 94% of physicians report delays in waiting for insurers to authorize necessary treatment. Equally concerning is that 80% of patients in the same survey say that the prior authorization process can sometimes cause them to abandon treatment. And 33% of physicians reported a serious event because prior authorization delayed or prevented care.

More study is certainly needed to better understand which patients are most affected by prior authorization delays. Today, data submitted by plans related to prior authorization for Medicare Advantage enrollees do not include race/ethnicity, sex, age, or diagnosed health conditions. Absent these data, we can’t establish whether prior authorization is limiting access to care and affecting outcomes in certain populations. Aggregating and analyzing these data should be a priority.

Impacts Across the Care Continuum

According to the 2022 CAQH Index Report, providers could save 11 minutes per case if they moved away from manual prior authorization. The annual cost savings possible across the medical industry would approach $449 million. Fortunately, progress is being made: According to the 2022 Index, increased automation and streamlined processes have resulted in savings of $187 billion annually.

As we celebrate progress, we must also acknowledge—if not spotlight—ongoing gaps that continue to affect efficient care delivery and outcomes, especially for certain populations. For instance, when a patient on medication changes insurers, she will likely have to revisit the onerous prior authorization process, even though she’s been adherent and doing well on that same medication for months, likely disrupting her treatment regimen.

The problem of time constraints only worsens as burnout and financial concerns force more clinicians to leave the industry, creating a vicious cycle as administrative burden contributes to further burnout and shortages. Pharmacies and other care sites are filling some of this void, but they also need time and record continuity to be most effective. Time diverted to manual processes is time a pharmacist or her organization cannot devote to the patient. Patients typically see their pharmacist twice as often as they see their primary care physician, so a massive opportunity is being wasted.

We must make it easier to access critical information via the cloud, essentially automating time-consuming processes such as prior authorization to save time while enabling data sharing across stakeholders to improve population health. Further, data must be complete and accurate if stakeholders including clinicians, care coordinators, pharmacists, and many others are going to use it to make clinical decisions that impact patient health and outcomes.

Better Health Care for All: It’s About Time

Place, race, culture, financial ability, and other factors play a role in determining patient outcomes, but you cannot properly assess all that without the time to ask. Promoting health equity isn’t only about consideration of underlying health risks; it’s also about using that data to inform population care as well as give clinicians and their teams more time with the patient in front of them. That is, after all, what they trained for. And the health care system cannot achieve equitable care until these data are accessible in the cloud and actionable for use for everyone, individually, and equally.