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Its funny reading the comments to your comment. For the most part people can't seem to distinguish claims data vs healthcare records...its pretty scary as thes

Its funny reading the comments to your comment. For the most part people can't seem to distinguish claims data vs healthcare records...its pretty scary as these are the most likely people to receive funding to "disrupt" the health care industry. Claims data is not equal to medical records, but to your point it is extremely valuable data and can easily act as a proxy for medical care. Even more so when tied together with Rx claims data. Even providers (Doctors/hospitals) themselves don't have access to insurance claims data for patients...which unironically results in perhaps a million hospitalizations and billions of dollars in healthcare costs per year because of the lack of data sharing with providers.

undefined3840 7y ago
It’s actually pretty shocking how few people seem to realize this about large employers...this is clearly not well understood at all.
samatman 7y ago
"potential founders of healthcare startups" are likely to be in the set "reads Hacker News", but would be a tiny subset. Even if they all know the difference between claims data and healthcare records, that wouldn't show up in the commentariat at large. Your fear is unfounded.
noelsusman 7y ago
As you mentioned, claims data is arguably worse from a privacy standpoint. I work for a hospital and we constantly struggle with the fact that we can't assume we have a full medical record for any given patient. As an easy example, we have no idea if our patients actually fill their prescriptions properly once they leave, making it impossible for us to do any sort of intervention on medication adherence. With that said, we actually do have access to claims data for a significant chunk of our patients now, and that percentage is growing fast. It's part of a big push towards shifting risk from payors to providers to incentivize cost reduction.
- throwaway_tech 7y ago
  >As an easy example, we have no idea if our patients actually fill their prescriptions properly once they leave, making it impossible for us to do any sort of intervention on medication adherence. This is probably the lowest hanging fruit of all waste in Medicare. Consider the average Medicare patient has 7 prescribing physicians and 10 prescription therapies, yet not a single physician has access to the claims data to see what another physician has prescribed, leading to duplicate therapies and adverse drug interacts at ridiculous rates. These are generally for chronic care patients also, meaning complications with diabetes, blood pressure, cholesterol, etc... resulting in costly hospitalization. MTM was a step to fixing these issues, I am guessing perhaps what you may be referencing in improvement in sharing claims data (maybe you use OutcomesMTM), but realistically MTM is just a program for insurers to monetize their claims data.

undefined3840 7y ago

It’s actually pretty shocking how few people seem to realize this about large employers...this is clearly not well understood at all.

samatman 7y ago

"potential founders of healthcare startups" are likely to be in the set "reads Hacker News", but would be a tiny subset. Even if they all know the difference between claims data and healthcare records, that wouldn't show up in the commentariat at large. Your fear is unfounded.

noelsusman 7y ago

As you mentioned, claims data is arguably worse from a privacy standpoint. I work for a hospital and we constantly struggle with the fact that we can't assume we have a full medical record for any given patient. As an easy example, we have no idea if our patients actually fill their prescriptions properly once they leave, making it impossible for us to do any sort of intervention on medication adherence. With that said, we actually do have access to claims data for a significant chunk of our patients now, and that percentage is growing fast. It's part of a big push towards shifting risk from payors to providers to incentivize cost reduction.

throwaway_tech 7y ago
>As an easy example, we have no idea if our patients actually fill their prescriptions properly once they leave, making it impossible for us to do any sort of intervention on medication adherence. This is probably the lowest hanging fruit of all waste in Medicare. Consider the average Medicare patient has 7 prescribing physicians and 10 prescription therapies, yet not a single physician has access to the claims data to see what another physician has prescribed, leading to duplicate therapies and adverse drug interacts at ridiculous rates. These are generally for chronic care patients also, meaning complications with diabetes, blood pressure, cholesterol, etc... resulting in costly hospitalization. MTM was a step to fixing these issues, I am guessing perhaps what you may be referencing in improvement in sharing claims data (maybe you use OutcomesMTM), but realistically MTM is just a program for insurers to monetize their claims data.