Solutions for Health Plans

Halfpenny's solutions for Health Plan Reporting include the capture of clinical data from numerous hospital and laboratory systems, aggregation in a common repository, matching with claims and payment data and the provision of a common, "normalized feed" (including LOINC mapping) back to the health plan. Through care management companies such as Thomson Reuters and LMS, Halfpenny's health plan solutions have been utilized by Aetna, Humana, Cigna, LabCorp, Pepsi Bottling Company and major payors, employers and laboratories.

Medicare and most private health plans are already aggressively implementing a number of initiatives in the areas of provider compliance, disease management, outcomes monitoring for improved quality and reduced cost of care and the related pay for performance (P4P) programs. More than 90 percent of U.S. health plans participate in the Healthcare Effectiveness Data and Information Set (HEDIS) administered by the National Committee for Quality Assurance (NCQA). However, the collection and assimilation of the desired clinical data is cumbersome, fragmented and incomplete.

All of the initiatives outlined above are dependent upon receiving "normalized" clinical data from providers which can then be merged with claims, remittance and eligibility data at a patient / encounter level and viewed and compared over a span of time. Healthcare payors face the same difficulty in acquiring normalized clinical data from the thousands of providers that produce the clinical data they require. Halfpenny's proven methods of clinical data capture, aggregation, normalization and archive / retrieval are being used for millions of covered lives to bridge the gap between claims information with discrete clinical data.