Health Insurers Reliance on Analytical Tools Creates Need for More Clinical Informaticists

– IT Professionals with Health Care Informatics Degree Play Important Role Analyzing Data to Generate Insights –

AURORA, Colo. – April 11, 2013 – Health insurers today face monumental changes in the way they use information technology to provide care metrics. Insurers that increasingly rely on analytical tools to identify the right patient data and incorporate informatics into their organizations to monitor costs are the most likely to transform health care and create a need for more informaticists.

“As the health care industry shifts to new payment models that pay for outcomes rather than for volume of services, health insurers are heavily investing in information technology that turns clinical analytics into business intelligence. And this means there will be burgeoning professional opportunities for clinical informaticists,” says Suzanne Richins, DHA, MBA, FACHE, RN, chair, health information management and health care administration at American Sentinel University.

Richins notes that insurers are using clinical data to assess patient outcomes and to determine best practices in terms of interacting with patients to improve health.

“Since insurers will no longer be able to reject consumers with pre-existing conditions, they’re shifting their focus to health outcomes in the insured population as a means of managing risk,” she adds.

For example, health insurers are now using hard data to drive initiatives with goals like preventing hospital readmissions, managing chronic diseases like diabetes more effectively, creating wellness programs, identifying fraud and abuse and tracking medication compliance.

In this way, the goals of health care providers and health care insurers have become more closely aligned: to collect and leverage clinical data in ways that can enhance care delivery, manage costs, maximize patient safety and ultimately improve the health of a whole population.

Where Health Care Informaticists Fit In

Richins points out that health insurers face challenges as they make the move to clinical analytics and says IT professionals with a health care informatics degree can play an important role assisting health care payers in their mission to analyze data to generate insights.

She says current specific challenges facing insurers include:

  • Data input. Clinical data, such as handwritten physician notes, still exists on paper and other electronic data comes from many sources (pharmacies, medical labs, etc.) and may be housed in databases that aren’t connected or compatible. Informaticists understand this fact and can use tools to get all relevant data into the system.
  • Data mapping. Once data is in the system, it must be mapped for extraction if it is to be available for analytics. This mapping is particularly challenging when data is not captured in discrete data elements, as it may have to be converted through an intermediate process. Informaticists know how to perform these conversions.
  • Incomplete data. When records are incomplete, data elements required for an accurate analysis may be missing. An informaticist must identify missing elements, know where to find them and acquire the data necessary to present a complete and accurate report.
  • Data insights. Raw data alone is often of little use. Informaticists can assist in translating raw data into business intelligence that an insurer can act on.

Richins notes that in order to address these specific challenges, organizations that truly innovate and lead in broad strategic planning for their organizations will be supported by IT professionals with a clear vision of the health care future, a strong clinical background and be armed with a degree in health care informatics.

American Sentinel’s online health informatics degree, the Master of Health Care Informatics (MHCI), offers a degree designed to provide skills in gathering, analyzing, and presenting health care data for clinical use.

Learn more about American Sentinel University’s Master of Informatics (MHCI) program.

About American Sentinel University

American Sentinel University is dedicated to delivering quality, affordable, online education in the fields of health care, technology and business. Its flexible bachelor’s and master’s nursing degree programs, including RN to MSN, Nursing Informatics, and are accredited by the Commission for the Collegiate Nursing Education (CCNE). Its MHCI program teaches students the management, integration, interpretation, and visualization skills needed to make organizational data usable for management and patient care decision-making and performance improvement. The university is accredited by the Distance Education and Training Council (DETC). The Accrediting Commission of DETC is listed by the U.S. Department of Education as a nationally recognized accrediting agency and is a recognized member of the Council for Higher Education Accreditation.