Encounter Data Improvement
For health plans and providers, timely, accurate, and complete encounter data is critical for understanding healthcare access, quality, and value. But encounter data collection and submission processes are complicated and prone to errors. That’s why IHA is stepping up as California’s Encounter Data Governance Entity.
Solving systemwide encounter data challenges
Navigating encounter data complexity and implementing standardized solutions to encounter data challenges is fundamental to advancing healthcare equity and affordability in California. As the Encounter Data Governance Entity (EDGE), IHA coordinated initiatives to improve how encounter data is collected, reported, and used.
What was IHA’s role as governance entity?
As part of Health Net’s Encounter Data Improvement Program, IHA coordinated encounter data improvement efforts across California.
Managed care in California relies on encounter data
Healthcare providers and health plans in managed care settings collect encounter data for each patient visit or interaction. The data documents clinical conditions and services provided and is later submitted to regulators for accountability purposes. Reliable data is essential for tracking healthcare quality and value, monitoring population health trends, providing care coordination, identifying deficiencies or gaps in care, and determining payment rates.
But poor quality and missing encounter data and unclear submission standards remain major challenges for California’s providers, health plans, and regulators. It’s time to align California’s healthcare community around the shared goal of addressing encounter data challenges statewide.
Measuring encounter data quality
You can’t improve what you can’t measure. Since 2007, IHA’s Align. Measure. Perform. (AMP) programs have used encounter data quality measures to support high-value care across California.
AMP gives participants the insights and incentives to improve the quality of their encounter data through our neutral results verification processes, our annual awards and public reporting, and our value-based incentive design.
In turn, analyzing aggregated encounter data quality performance helps us and our partners identify where workgroups and technical assistance can make the biggest impact.