He who has the data has the power! Now more than at any other time the aggregation and analysis of healthcare claims data can and should be used to modify provider behavior with solid information and peer related feedback.
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A team of seasoned healthcare professionals led by Lawrence Schimmel, M.D., FACS, has come together to found Qualmetrix, Inc. Qualmetrix is a medical analytics company that will accept data from payers and other sources and then organize and analyze the data within its proprietary database query system to provide information to its clients. According to Schimmel, “What we’re talking about is turning data into information. If I give you a number, that is data. If I give you a number in red, signifying poor performance that is information. We are providing an analysis not just crunching numbers."Historically, Access to Care, Cost of Care, Quality of Care, How Do We Pay for Care, and How Do We Deliver Care have been the primary issues that we have been dealing with in our country. Recent initiatives at healthcare reform have attempted to address these issues. But without a complete understanding of the problem, solutions will always be just out of our reach. The stakeholders all have a different solution for the problem but in the end the delivery of quality care in a cost effective fashion to all citizens of this country is a shared goal. Qualmetrix believes that the facilitation of care utilizing “best medical practices” that are targeted to “outcomes” will lead to both quality care and cost effective medicine. Utilizing retrospective health claims data will enable us to prospectively influence the delivery of care in our country.
In the United States more than 80% of all healthcare dollars spent are controlled by physicians. While the doctor controls the vast amount of money spent, they only receive approximately 21% of all healthcare dollars spent. To modify physician behavior as it relates to ordering of healthcare services without compromising the quality of care for the patient is the answer to our problem. In times when the health care system is under significant pressure, it is important to provide management and quality improvement teams with the specific information that they need to make appropriate and timely decisions. Qualmetrix will analyze data and be able to identify those physicians who deviate from an accepted evidence-based standard within the community as it relates to the best medical practices. These evidence-based standards are established by the medical specialty organizations in our country. This is not cookbook medicine, but medicine based on accepted national standards.
We will look at the determinants of care from different perspectives. Our query system will provide reports, profiles and other analytic tools that will evaluate the physician, the patient and the disease. By looking at all sides in the healthcare continuum, it will enable Qualmetrix to provide the information necessary to modify and enhance physician behavior.
In the late 90s, Dr. Schimmel was CEO of Allied Health Group. Allied paid healthcare claims throughout the United States and subsequently realized that the data that had been accumulated was a powerful tool in the evaluation and management of care. Assisting Allied, and a principal of Qualmetrix, is Tighe Shomer, M.D. Dr. Shomer has served as medical director for Met Life as well as a consultant for Towers Perrin and Value Health. Also joining the team is Kevin N. Fine, MHA, a nationally recognized healthcare executive and Dr. Donald Grossman an Internist with extensive expertise in Managed Care as Chief Medical Officer for Medicaid and Medicare Advantage Programs. Our IT team will be comprised of Joseph Vason who formerly was Director of IT of Allied Health Group, and William Sampsel who is the founder and president of Healthscope.
