Study Spotlights Patient Matching in the Payer Community

The Sequoia Project, a nonprofit and trusted advocate for nationwide health information exchange, patient identity management experts collaborated with the Blue Cross Blue Shield Association (BCBSA) to apply A Framework for Cross-Organizational Patient Identity Management for the payer community and develop person matching strategies. The Sequoia Project recently published Person Matching for Greater Interoperability: A Case Study for Payers, which demonstrates high matching accuracy rates, and provides actionable insights for improving person identity matching across the payer community, a critical component of successful health information exchange and interoperability. 

“Since our provider-focused framework was published in 2016 and revised in 2018, we’ve seen tremendous interest in how we apply those principles to raise the floor for interoperability,” says Mariann Yeager, CEO of The Sequoia Project. “When the Blue Cross Blue Shield Association agreed to collaborate on the application of these principles to the unique needs of the payer community, we were thrilled for the opportunity to work together to expand our thinking from ‘patient matching among providers’ to ‘person matching in other settings.’” 

The Sequoia Project published A Framework for Cross-Organizational Patient Identity Management with its research partner Intermountain Health Care in 2016. This pioneering, proposed framework for patient matching across disparate companies and organizations included a detailed provider-to-provider case study, actionable best practices, and a maturity model serving to create a roadmap for future growth and improvement in nationwide patient matching strategies. This sparked a national dialogue on the efficacy of the proposed framework, the formation of a Patient Identity Framework Work Group, and a disposition of the many hundreds of public comments received. The resulting 2018 Revised A Framework for Cross-Organizational Patient Identity Management has become indispensable guidance for providers and health information networks nationwide. 

The new case study is considered a supplement to this framework that continues to be downloaded daily. While this paper documents the journey of a specific payer entity to developing an algorithm with a 99.5% accuracy rate across 36 independent companies, the concepts and practices described can be applied to a broader payer population. 

“The ability to match someone with their health data—regardless if they’ve changed insurers—is critical to ensuring people receive the care they need and deserve,” says Rich Cullen, vice president at BCBSA. “To address this health industry need, we developed a way to safely and securely match a person’s health data from one Blue Cross and Blue Shield company to another. We believe this will lay the foundation for larger health data-sharing efforts within the broader health care system. We thank The Sequoia Project for their expertise and collaborative leadership, which is critical now as we continue to advance industry standards to make meaningful health information easily accessible.”  

Patients and government leadership expect health information to flow among the many types of care settings as well as to insurance companies and smartphone apps. The broader health care sector is entering the world of on-demand health information sharing across platforms not previously considered, and person matching will be essential to success in this expanded ecosystem. As the nation adopts new technologies and best practices to improve match rates, The Sequoia Project will continue to refine and share strategies in digital identity management and person matching. 

The Sequoia Project and BCBSA are hosting a free, public webinar on Tuesday, January 12, 2021, at 2:00 p.m. Eastern to share the details of this case study and concepts that may be applied to others. Register online: https://bit.ly/2IMvLwL. 

The Person Matching for Greater Interoperability: A Case Study for Payers is available to download now.

Source: The Sequoia Project