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Among people whose job it is to mine healthcare data for insights on population health and quality of care, there can be a tendency to assume that insights generated from one source of data (e.g., traditional Medicare) will naturally prove to hold true when applied globally to all patients and providers. After all, if there’s one thing clinicians hate, it’s being asked to treat patients differently based on the type of insurance they have. But be aware – even though the patient’s insurance may be the last thing on a provider’s mind when deciding on a treatment plan, when trying to accurately measure performance, it can have surprising downstream impacts that you may not expect.
Are you judging the quality of your provider group, facility, or network with data from just a single source or line of business? Are you using data from multiple sources or lines of business, but analyzing it all the same way? Using the 2015 Encounters data for all beneficiaries in both Medicare Advantage and Traditional Medicare, CareJourney has analyzed primary care practices that appear in each dataset. The results may challenge your assumptions.