Unifying health records remains a challenge, but the benefits of integrating disparate data could transform the industry
Healthcare payers, providers and agencies have traditionally struggled with unifying health records, but no longer is that a viable reason to put off what can be achieved today. It’s time more healthcare organizations seize the opportunity to create a strong data foundation that’s consolidated, transparent, secure and easily accessible.
Many healthcare organizations face the challenge of disparate data sources that sit in different warehouses and run on various legacy systems that cannot process data as fast as new solutions. They’ve been reluctant to merge records and move from legacy systems because of concerns around data availability, access, analysis and adoption. But with advancement in technology – such as artificial intelligence (AI), machine learning and computing power that can analyze large data sets at a reasonable cost – now is the time to liberate healthcare data from silos.
Power in unifying data
Some organizations are already leveraging the power of advanced technology to integrate disparate data to improve healthcare outcomes.
Let’s take health insurers as an example. Health payers have been challenged to fight staggering levels of fraud, waste and abuse that costs the industry as much as 10 percent of annual healthcare expenditures – or $380 billion each year, according to estimates. The effort to identify and minimize fraud lives primarily within Special Investigations Units (SIUs) and typically can only be identified post-pay, with a subsequent lengthy process to analyze, investigate and realize recoverable dollars.
However, with recent technology advancements, an evolution in healthcare cost containment is underway. A more holistic approach is taking shape beyond just fraud and post-pay to now include a pre-pay focus. Despite historical challenges of siloed data, organizational dynamics, rigorous compliance mandates, and outdated technology, many payer departments are collaborating more transparently to address these issues, leading to monumental savings and better stewardship of healthcare dollars.
Case-in-point: Healthcare insurer Highmark Inc. successfully consolidated data from different data warehouses, transaction systems and claims sets for AI analysis across multiple departments using a holistic view of payer, provider, and patient data. The unified data is helping to pinpoint increasingly sophisticated and pervasive schemes, uncover billing and payment errors, and identify patient connections across all providers. It also enables Highmark to develop a snapshot of patient history and look for treatment anomalies and gaps that could be problematic in ongoing treatment or services.
A holistic approach to data allows health plans to identify trends that intentionally or unintentionally waste money, and builds connections across various claim types to deliver prescriptive insights.
Some health payers are leveraging centralized data in different ways. Blue Cross North Carolina, for example, recently took steps to unify its member experience data. The healthcare insurer had been using multiple channels, vendors and listening platforms to aggregate and analyze member feedback, resulting in fragmented customer insight. Blue Cross NC partnered with Qualtrics to consolidate listening data for holistic views in a single repository, which reduced costs and improved member satisfaction.
Transparency for improved health outcomes
Creating a common data reference for all healthcare stakeholders will play a key part in driving the industry forward to more transparency, as well as providing better healthcare and treatment to patients. Imagine a future where different health insurance companies could share patient records from disparate data sources such as the doctor’s office, pharmacies, dentists, surgeons to rehabilitation treatments — these insights to a holistic healthcare record would make it easier to recommend and identify treatment plans for patients and improve quality of care.
As more healthcare tech startups provide secure access to holistic data, there are opportunities to transform the healthcare model from fee-for-service to value-based care. Access to a huge common healthcare dataset also allows for better benchmarking and population health management.
Integrating data for good
Across other industries, people and businesses are already benefiting from the integration of data. Take the financial sector, for example, consumers can holistically view their personal finances by using apps that merge account data from banks, credit cards and brokerages. For years, tech companies like Cloudera, Salesforce and Databricks have offered custom solutions that can integrate with businesses’ preferred tools to capture, unify and analyze data. These customized solutions integrate datasets from different platforms to offer businesses a complete end-to-end overview of all their systems and help businesses to improve their operations and services.
Healthcare plans and insurance organizations who take on the challenge of unifying all provider, patient and claims data in a single platform are rewarded with easily accessible healthcare data intelligence that provides transparency and insights for all stakeholders.
About Derik Ciccarelli
Derik Ciccarelli is a fraud analyst with Codoxo, a provider of healthcare artificial intelligence solutions for healthcare payers and agencies.