An in-depth, two-part series on the need to improve encounter data collection and reporting in California. Part one defines encounter data and how it differs from claims data, highlighting its connection with provider financial risk-sharing and health plan revenue. Part two discusses the crucial role accurate and complete encounter data plays in several California healthcare initiatives and an effort underway to clarify, standardize, and monitor encounter data collection and reporting statewide.
Integrated Healthcare Association (IHA)
Why use it
Curious what encounter data is and how it differs from claims data? Want to understand why encounter data is such a prominent source of healthcare information in California? Read our two-part series, which includes numerous links to relevant research and industry news, to get up to speed.
Who it’s for
This series is meant to introduce encounter data and why it matters to a general audience. It’s also for anyone wanting to better understand IHA’s Encounter Data Improvement program and how it supports our mission to advance high-value care.
Just like claims data, encounter data’s original purpose was to capture information to inform payment, a vital function for ensuring financial transparency and sustainability for healthcare stakeholders – including patients. But its uses today extend far beyond its original value proposition.
In fact, accurate and complete encounter data is pivotal as California works to advance the following healthcare priorities:
- Closing care gaps for patients and achieving health equity
- Evaluating the impact of CalAIM and new Medi-Cal managed care contracts
- Increasing the accuracy of patient risk-scores and supporting value-based care
- Reducing administrative burden for providers
- Supporting increased accountability through the California Health Care Payments Database and the Office of Affordability