Healthcare's Irony: Data That Doesn't Close Care Gaps or Improve Patient Outcomes

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Every Monday, a physician from MCHC Health Centers treats homeless patients in a Northern California shelter parking lot. Back at her clinic sits a multimillion-dollar electronic health record system. It can't document what she just did.

Without that documentation, those patients don't exist in risk adjustment calculations. Their complexity goes uncaptured. The care provided goes unreimbursed. This is how healthcare's data paradox destroys patient care.

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Mountains of Data, Zero Insight

Healthcare generates more data than almost any industry. Every prescription, lab result, diagnosis, procedure gets meticulously recorded. Yet organizations can't answer basic questions about their patients.

"We don't have access to our own data. It sits on the vendor side," explains Mallika Madakasira, Director of Population Health at MCHC Health Centers. 

Her organization serves 30,000 patients across four clinics, with 52% on Medicaid. They generate thousands of data points daily through their electronic health record. To analyze that information, to understand their patients' true needs, they must pay the vendor holding it hostage.

Netflix knows what you'll watch next. Your coffee shop tracks purchase patterns in real-time. Your physician? They can't even tell if you received care across town.

This is the devastating matrix for risk adjustment. Without comprehensive data about patient complexity, social needs, and care patterns, providers can't accurately capture the resources required to treat their population. 

This arrangement benefits everyone except patients. Vendors maintain revenue streams. Health systems avoid transparency. Payers limit risk exposure. 

Without data, the care givers at MCHC were flying blind. And they are not alone. 

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The 15% Delusion

The problem runs deeper than data access. Even when organizations control their data, they're capturing the wrong things.

Dr. David Nace, Chief Medical Officer at Innovaccer, shared research that should reshape everything: medical interventions drive only 15% of health outcomes. 

Social and environmental factors? 40% 

Individual behavior? 30% 

Genetics? 7%

Yet we've built a trillion-dollar system that funds, measures, and rewards only that 15%.

MCHC's providers see this daily. Patients miss dialysis because they lack transportation. Diabetes spirals out of control because they can't afford food. Mental health deteriorates from unstable housing. These factors determine outcomes more than any prescription, but they don't exist in risk adjustment models. There is no field for "patient lives in a car."

"We have a lot of what I call structural issues," Madakasira notes. "Housing, transportation, healthy food. If you don't have a roof on your head and if you don't have access to food, it's really hard to get a colonoscopy."

The current system creates a cruel irony. Organizations serving the most complex patients, those facing multiple social determinants, receive the least appropriate reimbursement because that complexity can't be documented in ways risk adjustment recognizes.

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Fixing the Healthcare Ecosystem: Categorically, Thoughtfully

MCHC stopped accepting this broken equation. Their community health teams now accompany providers to homeless shelters every Monday. While doctors provide medical care, teams help residents navigate housing applications, food assistance, and domestic violence resources. When over half your patients are on Medicaid, accurately documenting their true needs becomes essential for organizational sustainability.

But traditional EHRs can't capture this work. So MCHC made a radical decision: build their own data warehouse. 

"We have to become brilliant at the basics," Madakasira says. They're pulling data from vendor-controlled systems, combining it with claims data, adding community health information, creating a true picture of patient complexity. Each source speaks a different language. None were designed to work together.

The absurdity is breathtaking. A federally qualified health center is becoming a tech company just to understand their own patients.

While EHRs turned documentation into a barrier, emerging AI technologies are beginning to bridge the gap. 

AI scribing has transformed documentation by freeing providers to actually observe patients. Visit times dropped from 45 to 30 minutes, but the real victory was patient-centric human care delivery. "It enables them to focus on the patient and the conversation versus looking at a screen," Madakasira observes. 

Providers using scribes feel they're practicing medicine again. They catch subtle expressions signaling pain. They notice family dynamics affecting treatment. They have energy after the clinic to think about complex cases instead of completing documentation.

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The Convenient Fiction of Healthcare Interoperability

Even as organizations like MCHC prove better documentation is possible, systemic barriers remain.

"Healthcare is one of the few industries where entities are very protective about their data," Madakasira notes. When MCHC needs to know if a patient received care elsewhere, they resort to faxes, phone calls, and patients’ recollection. This fragmentation makes comprehensive risk adjustment impossible.

The resistance isn't accidental. Vendors profit from data lock-in. Payers benefit when provider complexity goes undocumented. Health systems avoid transparency about outcomes. Everyone protects their piece while patients fall through the cracks.

Dr. Nace calls interoperability a "north star," not a destination, because those who could fix it tomorrow profit from it being broken today. As long as data remains fragmented, true risk adjustment stays impossible. Organizations caring for complex populations will continue being underpaid. Care gaps will persist.

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Fix Risk Adjustment to Fix Patient Outcomes

What MCHC understands that others don't seem to: fix risk adjustment, and you fix healthcare's incentive problem.

When organizations can document and get reimbursed for addressing social determinants of health, they close more care gaps. This isn't idealism. It's economics. 

Providers stop treating symptoms and start addressing causes. Payers stop denying claims for "non-medical" interventions that prevent medical crises. Patients stop cycling through emergency rooms.

The technology exists. The data exists. The knowledge exists. What's missing is the will to acknowledge that our current risk adjustment system maintains inequality by design. It rewards treating sickness, not preventing it. It captures medical complexity while ignoring human complexity.

The transformation starts with a simple recognition: accurate risk adjustment requires capturing what actually drives health outcomes. Not just the 15% we've always measured, but the 85% we've ignored. Not just medical complexity, but social reality. Not just what happened in your facility, but across the care continuum.

The question isn't whether healthcare can capture and use comprehensive data for better risk adjustment. MCHC proves it can.

The question is whether you'll keep participating in a system that pretends otherwise while your patients suffer and your organization struggles.

This piece draws from the webinar "Driving Performance: Unlocking the Full Potential of Risk Adjustment Across the Care Continuum," featuring Mallika Madakasira (Director - Population Health, MCHC Health Centers), Dr. David Nace (Chief Medical Officer, Innovaccer), and Michelle Zilisch (Senior Director - Product Management, Innovaccer). 

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