How data helps us better care for you

By Regence
October 28, 2024
care manager

Everyone's health needs are different. That's why data is key to understanding each member’s unique circumstances and offering more personalized support. Access to data about factors such as: age, gender, sexual orientation, race, ethnicity, socioeconomic status, language preference, disability status, geographic location, and more, helps us identify patterns and trends that impact health and develop targeted programs that promote health equity.

What is health equity? 

Health equity means fair access to health care for everyone. While that may sound like a simple goal to reach, it’s not when you consider that demographics and common social factors, such as nutrition, housing, education, pollution and discrimination, influence up to 80% of your health.

Research shows that these factors—known as social determinants of health (SDOH)—also have a disproportionate impact on groups that are systemically excluded due to their demographics.

That’s why achieving health equity focuses on reducing the non-medical barriers that prevent people from getting good care. And it starts with developing a deeper understanding of our members’ lives through data. 

How do we use data to improve health outcomes? 

With demographic and SDOH data, we can peel back layers to understand the root causes of poor outcomes. This information can help us identify high-risk populations and tailor interventions to meet their unique needs. 

For instance, we might find that rural members face poorer maternal health outcomes due to limited access to maternity care. To address this, we could develop a telehealth program that connects rural members with obstetricians and other maternal health care specialists virtually, reducing the need for in-person visits and increasing access to care.

Partnering with providers to turn data into action – a member story 

Regence’s Care Management team provides members with one-on-one support when they need it most. Case managers are dedicated to helping members navigate the health care system, coordinate care, understand their benefits and access community resources. They’re often experienced registered nurses, social workers and behavioral health specialists. They work closely with providers virtually and on-site to improve members’ health and help them meet the goals of their providers' treatment plans. 

Shaleena Bilbrey, a registered nurse, is a Regence case manager embedded within a provider group as part of a pilot program. She was reviewing clinical records when she came across a 75-year-old member who had been hospitalized multiple times and was struggling to manage his medications. His records revealed a complex medical history, including heart disease, chronic obstructive pulmonary disease and schizophrenia.

Taking a closer look at the notes within his electronic medical record, Bilbrey found that the member primarily spoke Russian and needed an interpreter to communicate effectively. She partnered with his provider to arrange an interpreter for follow up care. Together, they rescheduled the member for a previously canceled appointment with palliative care, booked a routine wellness visit and provided advance care planning. This direct assistance helped improve the member’s medication management and compliance, reducing his risk for additional hospitalizations and emergency department visits.

"Case management is more than just coordinating care,” said Bilbrey. “It’s helping our members navigate the complexities of the health care system and advocating for their unique needs. When I’m reviewing medical records, my goal is to investigate what’s keeping a member from achieving their health care goals and bridge those gaps in care by teaming up with their providers." 

A key factor in the effectiveness of embedded case managers is that they partner with providers in real-time and can access patient data to proactively identify members who need more attention. By leveraging data to take a patient-centered approach and address the member’s unique needs, Bilbrey successfully improved this member’s overall care and well-being.

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