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Solving systemwide encounter data challenges

Navigating encounter data complexity and implementing standardized solutions to encounter data challenges is fundamental to advancing healthcare equity and affordability in California. As the Encounter Data Governance Entity (EDGE), IHA is coordinating initiatives to improve how encounter data is collected, reported, and used.

Central to the effort is IHA’s Encounter Data Resource Hub, where providers, health plans, and other stakeholders can easily access promising practices, helpful tools, and easy-to-use guidance.

What is IHA’s role as governance entity?

As part of Health Net’s Encounter Data Improvement Program, IHA is coordinating encounter data improvement efforts across California. We’re using our proven governance model to find consensus and accelerate change, all while ensuring project transparency and accountability. We’re working with partners to equip provider organizations with encounter data quality fundamentals and data submission guidance. And we’re engaging health plans, providers, and EHR vendors to find workable approaches to harmonize standards and processes.

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Managed care in California relies on encounter data

Healthcare providers and health plans in managed care settings collect encounter data for each patient visit or interaction. The data documents clinical conditions and services provided and is later submitted to regulators for accountability purposes. Reliable data is essential for tracking healthcare quality and value, monitoring population health trends, providing care coordination, identifying deficiencies or gaps in care, and determining payment rates.

But poor quality and missing encounter data and unclear submission standards remain major challenges for California’s providers, health plans, and regulators. It’s time to align California’s healthcare community around the shared goal of addressing encounter data challenges statewide.

Measuring encounter data quality

You can’t improve what you can’t measure. Since 2007, IHA’s Align. Measure. Perform. (AMP) programs have used encounter data quality measures to support high-value care across California.

AMP gives participants the insights and incentives to improve the quality of their encounter data through our neutral results verification processes, our annual awards and public reporting, and our value-based incentive design.

In turn, analyzing aggregated encounter data quality performance helps us and our partners identify where workgroups and technical assistance can make the biggest impact.

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How will IHA improve encounter data?

Funded by a milestones-based contract from Health Net, Inc, we’re taking a multi-pronged approach to move the needle on encounter data quality.

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Collaborating with health plans, providers, and data partners to develop standardized policies and practices that can resolve common pain points in encounter data submissions.

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Partnering with the California Department of Health Care Services and other key stakeholders to advance the goals of standardized reporting and  reliable assessments of provider and health plan performance.​

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Equipping providers with resources and technical assistance to integrate promising practices and consensus-based standards directly into point of care settings.

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Tying our efforts back to measurable changes in encounter data quality performance for providers and their contracted health plans.

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