Encounter Data
“Encounter data” is the administrative data sent to a payor for a patient visit that is not covered under fee-for-service arrangements. For Medi-Cal, it is the data sent to the California Department of Health Care Services (DHCS) describing the care provided to Medi-Cal Managed Care beneficiaries who are covered under capitation.
Encounter data has become increasingly important as Medi-Cal has dramatically increased the percentage of its beneficiaries in managed care, and as CMS has increased federal oversight of Medicaid managed care around the country.
Since encounter data is now used for capitation rate setting, reducing health disparities, measuring quality of care (i.e., HEDIS, etc.) and monitoring the Medi-Cal Managed Care program, improving the quality of this data is extremely important. Yet, for a variety of reasons, this data is often low-quality.
In 2012 DHCS began a series of projects to improve the quality of the encounter data it receives from managed care plans. Likewise, health plans, physicians associations, health care foundations, and providers have been working on initiatives to improve the quality of the data they collect and submit to the state.
The Blue Heeler Solutions team has been a key part of these initiatives, and can bring that perspective and experience to your encounter data improvement projects.
We know encounter data inside and out and look forward to helping your organization improve its data quality.
Data Quality Assessments
We assess every aspect of how your health care data is collected, stored, processed, monitored, corrected, and transmitted. We clarify the “as-is” state of your organization’s data quality – including business processes, data flows, technology infrastructure, and governance. Then we help you create a vision for the future with realistic and actionable plans to get there.
Data Quality Improvements
Blue Heeler Solutions can help you implement a data quality management program that addresses all dimensions of data quality. This includes quantifying and measuring quality; remediating the business, contractual, technical, and procedural issues that create data quality issues in the first place; and putting in place approaches for continuous quality improvement.
Business Intelligence
It is easy for an organization to be data-rich but information-poor. Your data should tell a story that can guide decisions in support of your strategic goals. Blue Heeler Solutions can help you implement business intelligence to transform data into information, and then re-engineer your business processes to integrate that information into your analytics and decision making.
Project Management
With experience in both the Project Management Body of Knowledge (PMBOK) and Scrum Agile methodologies, we understand that the purpose of project management is to shepherd the project to its goals, getting there on schedule and within budget – project management is a tool, not the goal. Our approach helps our clients realize value as soon as possible, while creating a path for continued growth over time.
Business Analysis
Business analysis, done well, can help find the way for a project to meet all the stakeholders’ needs. Business staff and technical staff do not always speak the same language. Blue Heeler Solutions’ analysts speak both “health care” and “technology” – they are the translators and ambassadors between these two different worlds, and can help you coordinate across that boundary.
Training
Blue Heeler Solutions offers innovative training packages, designed to expand the knowledge and skills of your team. Whether it is an introduction to Encounter Data, training for a new business process or data management program, or technical skills training for data analysts, our training improves your ability to pull meaningful, actionable stories out of massive health care information systems.
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