Electronic health records can be used as a source to validate a patient's health insurance coverage, which can help patients maintain insurance benefits and enjoy more continuity of care, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).
Health insurance is a vital aspect of improving patient care, and is now more available to low income and other Americans, due in part to the Affordable Care Act. However, people sometimes don't keep track of their coverage, don't renew it and don't look into other options.
The researchers, from Oregon Health and Science University and elsewhere, hypothesized that the information captured in EHRs could help primary care clinics validate insurance coverage in "real time" and then help patients with health insurance enrollment and retention support so that they would have health insurance stability. They proposed to devise a method to use EHRs to validate health insurance.
They analyzed three data sets--EHR coverage data, reimbursement data, and Medicaid coverage data--for 69,189 pediatric patients receiving care throughout 96 Oregon safety net clinics in the Oregon Community Health Information Network. They found that the EHR coverage information had "high" overall agreement with the reimbursement and Medicaid data sets, and that in some cases the EHR data was more accurate.
"Given that insurance significantly predicts healthcare utilization and outcomes, assistance with coverage enrollment and retention could be a potentially crucial service for clinics to provide and could be facilitated by data and tools from the EHR. Building tracking systems to improve insurance coverage is arguably as (or more) important to patients' health as systems to improve blood pressure and lipid levels. Our study presents validation for using the EHR as a source of health insurance information, and suggests that confidence in this information is possible," they stated.
They recommended further study in this area.
Improving patient health is one of the cornerstones of EHR adoption and of the shift from volume to value based care, which relies heavily on health IT support. Stage 3 of the Meaningful Use program focuses heavily on improving patient outcomes.
To learn more:
- read the study