In a healthcare landscape perpetually driven by data, the ability to harness insights from health data isn’t just a competitive edge — it’s a necessity for growth, efficiency, and improved outcomes. For those entrenched in the complexities of value-based care and other outcomes-based arrangements, the question is not whether to engage with health data, but how to do it effectively and across the entire enterprise.

To underscore the importance of effectively managing health data across the enterprise, consider this staggering statistic: it is estimated that the healthcare industry generates approximately 30% of the world’s data volume, with a single patient generating close to 80 megabytes per year in imaging and electronic health record (EHR) data alone. This exponential data growth, driven by technological advances and an increased focus on personalized medicine, presents an unprecedented opportunity for healthcare organizations. By leveraging AI-powered solutions, these entities could more effectively manage this vast influx of data and extract predictive insights that lead to improved patient outcomes and increased operational efficiencies.

Enterprises are experiencing an information explosion with data streaming from a myriad of sources. The defining challenge now is to transform this flood of information into actionable intelligence while maintaining the highest levels of security and compliance.

Despite the abundance of health data, accessibility of data remains a significant obstacle within and between organizations. The ability to retrieve, share, and utilize health information securely, including patient records, claims data, reports, and forms, is crucial. Health data is often siloed within each department of an organization, leading to inefficiencies and administrative waste. Achieving health data interoperability across organizations is challenging due to the lack of standardization, despite the emergence of new technology standards such as FHIR®. Data silos continue to exist, and we must ensure that data accessibility is enabled to promote patient-centered care.

For the past 14 years, Apixio has been delivering value to payers and providers by delivering insights from both structured and unstructured health data for AI-driven risk adjustment and payment integrity solutions. Drawing from our expertise in data and analytics, we are now expanding our health data infrastructure to payers and providers with Apixio Health Data Nexus™, empowering them to expand their healthcare capabilities and unlock new opportunities for enhancing efficiency and effectiveness across their operations. This transformative approach aims to redefine how organizations interact with health data, improving financial performance and enhancing patient outcomes in the process.

How Can Unifying Health Data Transform Your Organization

Unifying health data across your organization isn’t simply a matter of technological integration; it’s a foundational shift towards a more agile, informed, and patient-centric model of care. By consolidating disparate data sources into a single, accessible, and actionable place, healthcare organizations can achieve a holistic view of patient health, streamlining processes and enhancing decision-making. This unified data approach enables predictive analytics, which goes beyond traditional reactive care models to forecast patient risks and needs, allowing for preemptive health interventions.

In this era of digital transformation, the power of AI to interpret vast amounts of unstructured data—from physician’s notes to radiology reports—transforms mere information into precise, actionable insights. Apixio’s solution is designed to not only assimilate and analyze this data but also to extract meaningful patterns using AI and advanced search capabilities that drive better patient care, streamline administrative needs, and improve financial performance.

Benefits for Health Plans

For health plans, claims, billing, and medical records are major data sources that are leveraged across the enterprise. Still, each department leverages that data in silos that limit the level of insights at a provider-to-member level.

Here are examples of how payers can leverage Health Data Nexus across the enterprise:

• Risk Adjustment: With the different activities of suspecting, chart chasing, chart reviews, and auditing, multiple vendors and in-house team members share data and insights back and forth, but not in a centralized system. Health Data Nexus enables to be that hub to securely access, find, analyze, and share data and insights.
• Quality: Leveraging non-standard supplemental data makes extracting value difficult because the data is locked in unstructured formats in medical records or forms. In Health Data Nexus, charts are processed and normalized, enabling advanced search to close quality gaps.
• Payment Integrity: With managing costs a priority, health plans want to help providers be more proactive. Health Data Nexus enables payers to support provider education leveraging analytics and insights to help avoid costly errors and mistakes.

For health plans, integrating AI and machine learning into healthcare data analytics represents a paradigm shift in how member data can be leveraged to drive cost savings and improve patient care. With Apixio’s advanced analytics solutions, payers gain unprecedented access to deep insights into patient health trends, provider performance, and healthcare outcomes. Our technology enables the identification of gaps in care, the potential for improved care management programs, and opportunities for proactive health interventions. This ensures a higher quality of care for members and significantly reduces wasteful spending by targeting interventions more effectively.

In essence, our AI-driven solution equips payers with the tools necessary to transition to outcomes-based reimbursement. By harnessing the full potential of health data, payers are poised to lead the transformation towards more efficient, effective, and patient-centered healthcare.

Benefits for Providers

Leveraging AI-driven insights from Apixio’s solutions marks a critical step forward for providers in enhancing clinical outcomes and operational efficiency. By having access to a richer, more comprehensive dataset, providers can refine diagnosis accuracy, tailor treatment plans to individual patient needs, identify at-risk patients earlier in their care journey, and ensure a more complete and accurate patient record. This level of healthcare delivery, powered by our proprietary analytics, not only elevates patient care but also helps manage costs.

Here are examples of how providers can leverage Health Data Nexus:

• Risk Adjustment: Health systems may work with IPAs that are on different EHRs and need access to medical records, but it’s difficult to access and share. Health Data Nexus enables providers to acquire and centralize the charts to be leveraged for chart reviews.
• Care Delivery: Clinicians are overloaded with data and have trouble pulling the necessary insights to support patient care. Health Data Nexus enables clinicians to faster clinical decision-making with a comprehensive provider and patient profile to understand relevant and actionable insights from EHRs, lab results, radiology reports, and others to enable better patient care.
• Population Health Management: Managing at-risk populations is difficult if you don’t have the data, analytics, and insights to monitor trends and intervene at the right time. Health Data Nexus allows population health teams to stratify the data and insights from looking at in-patient hospitalization, 30-day readmission rates, or high-caution medications across the population and down to the patient-level to quickly make decisions on interventions and care programs.

Our technology offers a pathway to substantially decrease administrative burdens by automating data extraction and analysis processes. Thus, healthcare providers have more time to focus on patient care rather than manual work. By integrating and synthesizing health data from various sources, we enable a seamless flow of information across health systems and a more holistic view of a patient’s health history.

In a landscape where patient outcomes and satisfaction increasingly measure the efficacy of healthcare delivery, Apixio Health Data Nexus enables providers to deliver better patient care but is also positioned to excel in value-based care arrangements. These advantages underscore our commitment to advancing health outcomes and operational excellence for our partners in the healthcare industry.

Conclusion

The healthcare industry’s transformation through AI and machine learning is not merely imminent; it’s happening now. Apixio Health Data Nexus stands at the forefront of this evolution, enabling health plans and providers to leverage unprecedented insights to drive decision-making, improve outcomes, and optimize reimbursement models. Our commitment to transforming health data into actionable intelligence equips healthcare leaders with the tools to not only meet but surpass the demands of today’s dynamic healthcare environment, ensuring resilience, agility, and continuous innovation. Join us in redefining what’s possible in healthcare, where data-driven decisions lead to healthier populations and a more sustainable healthcare model for all.

Learn more about Apixio Health Data Nexus.