See the Whole Picture:
Why EHR + ACCURATE Claims Integration Powers Better Performance in Value-Based Care
In today’s healthcare landscape, EHRs and population health platforms drive most analytics — but they only tell part of the story.
EHRs capture what happened within your four walls.
Claims show what happened everywhere else.
Without integrating these two sources, health systems make decisions based on incomplete visibility.
The Power of Integration
When multi-payer claims are integrated into your EHR and analytics systems:
- You see care delivered inside and outside the network.
- You understand what was reimbursed.
- You identify gaps and utilization patterns that clinical data alone misses.
How Does Claims Data Support Value-Based Care (VBC) Success?
Understanding the specific ways that high-quality claims data can support value-based care success helps illustrate why the current data confidence crisis is so problematic for healthcare organizations. Ultimately, poor performance in value-based care equates to revenue loss, as reimbursements are tied to key performance measures. Healthcare organizations that aren’t able to shore up performance in the following key areas are leaving money on the table and ceding their competitive position. Claims data helps drive better performance in VBC in the following areas:
Quality Measures: Claims data is the primary source of data used to calculate HEDIS measures, as it provides a complete picture of care provided regardless of where it was provided. Providers who have ongoing, reliable insight into their HEDIS performance gain a significant advantage in demonstrating their value to payers and can proactively address potential quality issues before they impact contract performance.
Ongoing Contract Management: Claims data provides visibility into performance that allows providers to be strategic about what’s included in contracts, identify opportunities to improve performance for more revenue, manage downside risk, and meet compliance goals.
Network Analysis: Claims data enables sophisticated assessment of network adequacy, analysis of referral patterns, and strategic planning for network expansion based on actual utilization patterns. This intelligence is crucial for optimizing provider networks and minimizing leakage.
Contract Negotiation with Commercial Payers: Historical claims data provides the analytical foundation for strategic contract negotiations. It allows providers to understand their actual performance patterns, identify areas of strength and opportunity, and negotiate terms that align with their capabilities and patient population characteristics.
Closing Gaps in Care: Claims data analysis allows providers to see the most comprehensive picture of care, which allows them to be proactive in reducing gaps in care, particularly for chronic conditions. Care gaps show discrepancies between best practices and actual care. They are not only significant for the delivery of optimal care and value, but also important because the financial penalties that may be linked to them in VBC contracts affect the organization’s bottom line. Analyzing claims data enables a more comprehensive view of patient care, and therefore, more accurate reporting.
Cost and Utilization Management: Claims data can be used for identification of high-cost diagnoses, providers, and patients, which can in turn be used to address poor performers that may be unnecessarily contributing to high costs.
Minimizing Leakage: Claims data can be used to identify network leakage and related insights, including the best practices of the highest performing providers. It can also help determine provider reimbursements related to high performance, so as to retain those providers and keep patients in-network.
Actuarial Review and Rate Setting: Claims data helps with stratifying populations by risk, forecasting utilization and costs, and benchmarking based on historical costs of care across providers, in or out of network.
The Power of Accurate Data
This isn’t only about complete data. It’s also about accurate data — unified, validated, and integrated correctly. Our recent Market Report reveals that there is a “confidence gap” in healthcare data quality.
The Confidence Crisis
Despite the widespread recognition of claims data’s importance, healthcare leaders express surprisingly low confidence in the data they’re using. A majority—65%—of survey respondents lack confidence in the quality and accuracy of their claims data. This means that nearly two-thirds of healthcare organizations are making critical VBC decisions based on data they fundamentally question.
That lack of confidence stems from “messy” healthcare claims data and slow and inconsistent, often manual, error-prone processes. More than three in four healthcare leaders characterized the effort of integrating claims data as “somewhat” to “extremely” challenging, a possible indicator that difficulties are not isolated incidents but rather systemic problems.
Since 2010, HDI has focused solely on aggregating and integrating payer claims data. We have a comprehensive data quality process that delivers accurate data before it is ingested into health systems’ analytics tools for confidence in data, analytics, and decisions.
Aggregate Once, Deliver Everywhere
HDI delivers high-quality data in the format your systems require, which provides a single source of truth across analytics platforms. We aggregate payer claims data and provide analytically ready data for ingestion into Epic, Arcadia, Innovaccer, Tuva, client data warehouses, and other analytics platforms to give leaders:
- A single, reconciled view of member and provider activity.
- Accurate attribution for risk and quality programs.
- Timely updates that support ongoing value-based care initiatives.
- Confidence in the insights driving operational and financial decisions.
Our clients see faster analytics, fewer delays, and stronger ROI because their systems finally speak the same data language.
Why Speed Matters
When integration is delayed, insights become less relevant.
When integration is fast and accurate, analytics can move at the speed of your business.
Weeks, not months — that’s how long it takes HDI to implement a health system and deliver clean, validated data to your existing tools. We deliver ongoing updates typically in 24 hours within receipt of payer claims data.
Leadership Takeaway
AI and analytics can’t thrive in data silos.
Integrating claims with EHRs and population health systems bridges the gap between clinical care and financial truth — powering insights that are trusted, actionable, and scalable.
Learn more about the data “Confidence Gap” in healthcare claims data:
