In April, NextGen Healthcare’s leadership team met with leaders of provider organizations representing a range of specialties and geographies. One of the themes that came through loud and clear was their ongoing struggle to obtain claims data from their payers. As providers continue their efforts to navigate alternative payment models (APM) their need for global claims data becomes a more pressing issue. Many providers are still in a position with little or no downside risk. Even in this early stage claims data is important. Many of the quality metrics require claims data in order for providers to fully understand their performance. It’s common that services not performed by primary care doctors will not be fully captured in their own EHR. Colonoscopy, mammography, and diabetic retinal screening are good examples of this phenomenon. Perhaps less obvious is the need for claims data in the context of gainsharing arrangements even when there is no downside risk. Providers in this setting need to manage costs in order to maximize their upside potential and can’t really do that in that absence of a timely, robust claims feed from the payer. Learning how to identify and act on opportunities apparent in claims data will both maximize current opportunities and prepare provider organizations for downside risk in the future. Claims data, at its best, is generally three months behind point of care in terms of giving a clear picture of utilization and cost. This is because it takes that long for an adequate percentage of the claims from a given month to be submitted to the health plan. As a result, claims data is useful for planning and for retrospectively evaluating performance, but has limited value in real time. For providers entering contracts with downside risk, a claims database that shows utilization and cost trends as well as performance against regional and national benchmarks can be extremely helpful in identifying opportunities and prioritizing resource allocation for planned interventions. This same database can also serve as a critical supplement to real time data that providers obtain through their EHR. A population health platform enables an integrated view that brings together claims data, EHR data, and other information sources such as a health information exchange (HIE). That approach is foundational to any organization that is committed to APMs that include downside risk.