The Sequoia Undertaking, a healthcare interoperability not-for-profit, on Thursday launched a complement to a patient-matching framework it launched in 2018, this time specializing in matching folks between payers.
The complement, a case research with the Blue Cross and Blue Defend Affiliation, reviews reaching a 99.5% accuracy price when matching members to their information by creating a brand new member-matching algorithm, making use of ideas from the Sequoia Undertaking’s 2018 framework for cross-organizational affected person identification administration.
Precisely matching folks throughout care settings, payers and well being data networks is foundational for attaining interoperability in healthcare, a core focus of the trade and federal authorities lately. HHS’ Workplace of the Nationwide Coordinator for Well being Data Know-how and CMS in March launched companion guidelines on interoperability, enforcement of which has been delayed amid COVID-19.
Affected person matching is “essential to be able to have interoperable well being data change,” stated Mariann Yeager, the Sequoia Undertaking’s CEO. “It’s important to know that you simply’re speaking about the identical particular person.”
Whereas the Sequoia Undertaking’s 2018 framework constructed upon a case research on matching affected person information between healthcare suppliers that it accomplished with Intermountain Healthcare in 2016, the case research launched Thursday with BCBSA adapts that framework to attempt to define methods for payers.
“BCBSA’s work round creating an individual matching answer was a narrative all of us felt wanted to be advised from a payer’s perspective as the main target within the trade thus far has been primarily in supplier settings,” a BCBSA spokesperson wrote in an e mail to Fashionable Healthcare.
Payers additionally face challenges when matching a member to their earlier information, significantly after a member transitions to a different well being plan.
Correct matching can be vital to making sure the proper well being information are delivered to healthcare suppliers, nationwide healthcare information networks and particular person members when wanted.
“No matter any payer’s enterprise construction, the truth is that people continuously change insurance policy,” reads the case research from the Sequoia Undertaking. “The top consequence for all payers is that they face the identical drawback of linking healthcare providers offered to a person over time.”
For its matching program, BCBSA deployed an algorithmic matching course of to enhance how its 36 Blue Cross and Blue Defend firms matched members’ well being information between each other.
BCBSA’s proprietary algorithm assigns a singular identification quantity to every particular person, which is used to hyperlink their information throughout your complete BCBS system. That quantity is shared with particular person BCBS firms to make use of for duties like requesting information from different BCBS firms that a member has beforehand obtained providers from.
BCBSA’s program brings collectively a third-party vendor’s probabilistic matching device—which compares a number of information components, like members’ names and addresses, to find out the probability of two information being from the identical member—with extra payer-specific algorithmic guidelines developed by BCBSA.
BCBSA additionally labored with an organization that brings in publicly out there third-party information to help and confirm patient-matching selections.
For example of a lesson discovered by means of the mission, BCBSA shared its discovering that together with e mail addresses and telephone numbers truly lowered the matching success price for well being plans, for the reason that algorithm might get confused if a guardian used their similar contact data for his or her little one. BCBSA determined these elements shouldn’t be weighed closely in figuring out the probability of a match.
To this point, the algorithm has recognized greater than 93.5 million separate members with 99.5% matching accuracy, in keeping with the case research.
However the matching program, whereas profitable, concerned important workflow changes, coaching and different steps past creating and deploying the algorithm—the algorithm wasn’t a silver bullet.
Beforehand, every BCBS firm had established its personal information high quality methods and metrics. To efficiently onboard a BCBS firm to take part within the matching program, the mission leaders carried out a knowledge high quality evaluation and applied modifications to make sure every firm had ample information administration practices in place.
“The power to match somebody with their well being information—regardless in the event that they’ve modified insurers—is vital to making sure folks obtain the care they want and deserve,” stated Wealthy Cullen, vp at BCBSA, in a press release. “We consider this can lay the inspiration for bigger well being data-sharing efforts throughout the broader healthcare system.”