Medicare Claims Data Sources & Use Cases
Kris Gates
SaaS Founder | Healthcare Strategy | Adapting VBC Strategy for Success | Paradigm Shift to High-Revenue Preventive Care Models | Rethink Healthcare to be Accessible, Affordable, and High-Quality
Some specific use cases for care management:
1.??????Probability of High-Cost Patient Encounter:?The probability of a hospital or emergency visit encounter during the current year using claims data to run a probability model based on risk scores, diagnoses, and other historical data.
2.??????Medication Adherence:?The probability of a medication adherence encounter during the current year using claims data to identify a) drugs prescribed, picked up once, and not picked up again; and b) drug not prescribed but patient has a diagnosis correlated to maintenance medications.
3.??????Out-of-Network Encounters:?Review patient’s out-of-network encounters to redirect the patient to care-managed in-network providers if applicable.?
Book an appointment with me to discuss additional use cases.
Kris Gates, [email protected]
MD, MBA | Pediatrician at Schnieder Children’s Hospital, Health-Tech Innovation Advisor
2 年What's the source of the table?