Data the Silent Killer
As a seasoned veteran in healthcare operations I’ve seen firsthand the progression of data utilization by health plans. Despite decades of growth we’re not there yet.
In the 1950s and 60s data processing began to take hold. Unfiltered data was the norm. Not much was done with it. Data validation was in its infancy. Business decisions were mostly driven by non-analytical factors.
In the 1970s and 80s information management began grouping similar data and identifying patterns. Basic analytics such as the categorization of data facilitated the ability to draw certain assumptions. On occasion those assumptions were valid but, more often than not, not broadly applicable. We realized what making “assumptions” yielded.
Data usage and sophistication improved considerably in the 1990s and early 2000s. The ability to dig much deeper into the groupings of data to find those unique characteristics to either prove or invalidate business assumptions became the mainstay. Better analytical processes improved knowledge and predictability in business decisions. Data management was equated to business intelligence, highlighting the awareness that data functions effectively drive business operations. Improved ability to manage and report data ushered the evolution of Big Data. Analytics and reporting is assumed (there’s that word again) to be truthful…the data doesn’t lie!
Today, health plan data is heavily relied upon. Data must be valid, accurate, and reproducible; it is the sole factor for health plan payments, performance ratings, patient care plans, and just about every other aspect of health plan operations. Data has become the lifeblood of a managed care organization. But…what if your data is distorted and data leakage is occurring?
What if claims and encounters are improperly adjudicated and reported?
What if membership and provider data is inaccurate?
What if the data used in Disease Management programs relies incorrect metrics to optimize interventions?
What if the data required for risk adjustment submission and payment is inaccurate? How much will it cost your plan?
Poor data management, inaccurate and inadequate analytics can slowly drain a health plan of its revenue and ability to make strategic business decisions. Consider this much like high blood pressure is the silent killer in human beings; data leakage is the silent killer of health plans.
Gorman Health Group has decades of experience assisting health plans with their data management. Please contact us for an End-to-End Data Management Assessment. We will assess the current state of your Data Management against industry best practices and your desired future state, and we’ll assist you in getting there. Let us help you identify and control your health plan Silent Killer.
Resources
Join us on September 19 for an in-depth discussion on the end-to-end management of data from noting identified gaps in data processing, concerns regarding data completeness and accuracy. Register now >>
Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>