Solving the Patient Matching Problem

One of the early stories in healthcare news for 2019 revolved around the question of patient matching. The Government Accountability Office released a report revealing that two base-level problems continue to make matching difficult: records corresponding to the wrong patient are often matched, and multiple existing records for the same patient are not matched.

The report took into account interviews with a wide range of providers and vendors. The conversation centered in part around what standards would effectively make a dent in the problem. Many ideas focus on the concept of standardizing the systems for collecting healthcare-related data.

This is one of the essential flaws that the Health Rosetta paradigm has already been seeking to fix — and at Captiva Benefit Solutions, we’ve been helping businesses use their model to effectively create change.

First, it’s important to understand what exactly this efficiency problem is costing us.

The reality is that in a lot of companies, 6% of the employees are spending 80% of the health benefit plan dollars. Those employees are those with complex, usually chronic health challenges, needing specialist care. These patients are often referred to as “outliers” within the medical system.

With complex health problems, usually multiple specialists are involved. With poor patient matching and scattered models of care, often those specialists are not in communication and cannot access all of the data on an outlier’s needs. This leads to an abundance of procedures and tests that actually were not necessary.

For example, some studies show that as many of 40% of transplants are unnecessary. Some patients are receiving transplants where they are not needed, while others are on endless waiting lists due to short supply caused by poor communication.

The cost is clear: expensive procedures that eat up plan dollars plus a significant cost in time and suffering for patients.  

The Health Rosetta solution is to hone in on a network of confirmed, credible care providers, removing hospitals that are unlikely to be a good fit from the equation.

Often, this involves developing direct contracts with "centers of excellence" that are able to serve as referral centers, offering second opinions and connecting patients with the highest quality specialists.

Narrowing the field of options for all patients, including outliers, makes it significantly easier for the right data to get to the right person. Another way that patient matching process is streamlined is through placing the primary care physician as the central hub of anyone’s care.

These direct relationships between care providers and benefit providers cut out the middlemen and clearly define a path for moving through the appropriate care plan for even the most complex cases.

The return on your investment as a provider of benefits becomes significantly higher.

With higher quality care provided at a lower cost to everyone involved, it’s clear to see why the Health Rosetta’s model is already solving the healthcare problems the news is talking about.

Find out more about our approach to saving you and your employees money on benefits!

Solving the Patient Matching Problem is available on: Captiva Benefit