How to Drive Proactive Interventions with BCDA Insights

The BCDA (Beneficiary Claims Data API) is a powerful tool made available by CMS (Centers for Medicare and Medicaid Services), allowing providers access to timely insights from Medicare claims data. This helps providers facilitate proactive interventions aimed at preventing potential health problems and optimizing healthcare delivery.

As a provider, leveraging BCDA insights is the key to delivering high-quality care and meeting the needs of patient populations as quickly as possible. While ADT (Admission, Discharge, Transfer) and CCLF (Claim & Claim Line Feed) provide important healthcare utilization information, BCDA offers the most comprehensive data across a population. In addition, BCDA can combine with ADT data feeds to provide an enhanced holistic view of patient groups and their health needs.

In this blog, we’ll explore three ways providers apply BCDA data to drive more proactive care in partnership with Arcadia and CareJourney.

3 Ways BCDA Insights Drive Action

1. Improve Care Coordination

Providers depend on comprehensive data and intuitive tools to facilitate improved quality of care. According to Arcadia, care management software facilitates proactive intervention strategies by digging into patient history and creating actionable prevention plans. Integrating BCDA insights with this software equips healthcare providers to identify high-risk patients and address complex health needs.

This empowers providers to improve care coordination with:

• Preventive health screenings: BCDA captures patients’ healthcare utilization history, allowing providers to identify patients without recommended screenings and reach out with the appropriate care.
• Medication adherence programs: By tracking patients’ medication adherence patterns with BCDA, providers send targeted medication reminders and educational materials to improve adherence.
• Transitions of care: Providers identify patients at risk of adverse events within the BCDA feeds and intervene through effective communication and follow-up.
• Chronic disease management: BCDA flags chronic diseases, such as diabetes and kidney disease, as early as possible. From this, providers develop personalized care plans and encourage patients to engage in self-management strategies to proactively address these conditions and improve their health status.
• Health education campaigns: Insights from BCDA inform targeted health education campaigns, allowing providers to address gaps in healthcare knowledge. This may include sharing educational materials on a health organization’s website, hosting community events, or offering workshops. These campaigns empower patients to proactively participate in their care by adopting healthy behaviors.

Care coordination, especially chronic disease management, can focus on the potential adverse events and costs associated with delaying getting the patient on the right trajectory. Also, improved care coordination can instill trust in providers and care managers.

2. Guide ACO Operation Improvements

BCDA provides ACOs (Accountable Care Organizations) with valuable insights for monitoring and improving operations. These insights help ACOs identify areas for operational improvement and implement data-backed strategies to provide better patient care and improved performance across a performance year.

While BCDA insights target a variety of care delivery aspects, key process improvements guided by BCDA also include:

• Cost and Utilization Tracking: Timely BCDA data provides ACOs with utilization, costs, and outcomes needed to track key performance metrics over time. This enables ACOs to benchmark their performance against industry standards and conduct trend analyses to support continuous improvement efforts.
• Patient engagement: BCDA identifies gaps in patient engagement data to formulate and implement re-engagement strategies. This includes utilizing patient profiles to personalize outreach efforts and target health education campaigns.
• Referral management: BCDA insights highlight care delivery inefficiencies, such as patient referral delays, and empower providers to proactively address them by implementing referral management protocols. Additionally, BCDA data paired with provider intelligence data helps patients receive the appropriate referrals to high-value providers with expertise in the patient’s specific treatment area.
• Gap identification and risk adjustment: When paired with insights from risk adjustment software, BCDA data also helps providers predict the likelihood of healthcare service usage and any associated costs. This comprehensive risk assessment allows providers to tailor care plans based on each patient’s unique needs.