FIM program monitoring and evaluation requires data from multiple sources to assess program benefits, barriers, clinical outcomes, costs, and participant experiences. Data sources answer specific questions and have benefits and challenges.
Claims and Encounters
Purpose:
- Data used for medical billing and payment from insurance.
Example Outcomes:
- Total healthcare costs
- Hospitalizations
- Emergency department visits
- Outpatient specialty visits
- Primary care visits
- Specific procedures, surgeries, or treatments
Benefits:
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Reliable for data that are linked to payments and health care use.
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Can access data across multiple health systems when partnering with an insurer.
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Data can be used to identify diagnoses because claims are associated with ICD-10 codes describing conditions.
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Useful for determining overall cost-effectiveness of FIM programs.
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Most important outcome from an insurer’s perspective.
Challenges:
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Biggest challenge is that these data are designed and implemented for billing and compliance, not to actually capture important outcomes accurately.
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Has significant missing data when patients receive care at multiple health systems.
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Can miss details in medical record data.
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6-to 12-month delay in the accuracy of claims data as payments are negotiated, paid and adjudicated.
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Hospitalizations and ED visits may be unusual events in more general patient populations, requiring a large number of program participants to detect differences.
Electronic Health Records
Purpose:
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Data used by physicians and care team members to track health and plan treatments.
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Claims and encounters data used for utilization and ROI evaluation.
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Medical records used for tracking biological health for treatment effectiveness.
Example Outcomes:
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Height, weight, BMI
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Blood pressure
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Lab measurements
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Scans and test results
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Diagnoses
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Mental health screening responses
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Medications
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SDOH
Benefits:
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Measures clinical and biological health outcomes.
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May be more sensitive to change than healthcare utilization outcomes.
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Important outcomes from a clinician’s perspective.
Challenges:
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Requires careful cleaning before use due to frequent data entry errors.
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Timing of measurement aligns with clinical care decisions, not the timing of FIM services receipt.
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Missing values may be common.
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Decisions to obtain or not obtain a measure (e.g., HbA1c) may be dependent on patient, clinician, and insurance program factors, resulting in bias in missingness.
Direct Patient Surveys
Purpose:
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Allow participants to report direct experiences.
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May be used in clinical care (i.e., depression screening) or implemented outside of clinical care to build out evaluation and research (i.e., dietary assessment).
Example Outcomes:
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Food and nutrition insecurity
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Dietary habits
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Program use, compliance, satisfaction
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Other SDOH, life circumstances
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Mental health outcomes
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Self-reported health status
Benefits:
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Can measure impacts on dietary intake and mental/ behavioral health outcomes.
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May be available as part of the screening for FIM program eligibility.
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Useful for program monitoring and identifying successes and challenges in FIM program implementation.
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Allows participants to make direct recommendations for program improvements.
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Provides evidence on self-reported outcomes that are important to patients.
Challenges:
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Requires additional design, implementation, data collection, and analysis.
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Survey length and detail may be limited, given constraints on participant time.
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May have reporting bias (e.g., patients may respond how they think their provider or program wants them to respond).
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For outcomes like program use, compliance, satisfaction, previously validated tools may not be available.
Interviews, Focus Groups
Purpose:
- Allow evaluators to better understand personal experiences, important factors across their life, and how these conditions intersect with their health, access to food, and diet. Interviews can be done one on one, or in a group format through focus groups.
Example Outcomes:
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Personal experiences and stories
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Facilitators and barriers to FIM program participants
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Recommendations for program improvements
Benefits:
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Can help identify nuanced successes and challenges in FIM program implementation.
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Allows participants to make direct recommendations for program improvements.
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Provides real-world descriptions of the conditions behind more quantitative data.
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Effective for communicating patient stories to health system leaders, policy makers, funders.
Challenges:
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Requires expertise in qualitative research design and analysis.
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Time-consuming for staff and patients.
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May not be generalizable beyond the program or even the participants interviewed.