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TDWI Upside - Where Data Means Business

How Healthcare’s Data Management Approach Will Mature in 2019

Meeting growth in value-based care and patient consumerism requires health systems’ enterprise data management to include a robust provider data model.

The healthcare industry has been late to the big data party. As healthcare’s use of big data continues to mature, however, it will increasingly follow the more sophisticated consumer marketing behavior of other industries. This maturation is based on healthcare leaders’ recognition that they must take a broader and more strategic view of information.

For Further Reading:

Q&A: How Analytics May Improve Healthcare Outcomes

Healthcare Analytics in the Face of Heavy Volume

The New Ethics of Data Management

Healthcare networks have used big data primarily to focus on improving population health, a necessary application within the overall healthcare value chain. By collectively focusing on sets of data specific to certain high-risk patients -- based on age, gender, or medical history -- health networks are successfully using data to slow health care cost inflation.

Healthcare must now take its data management game to an enterprise level, one that spans the end-to-end value chain. Making that shift will require focusing beyond patient data.

Identifying the Right Data for Strategic Advantage

How can health systems manage the abundance of data now available and the challenges that come with it? Success starts with a clear data management plan that segments data into relevant and manageable use cases that support a health system’s strategic initiatives. The ability to segment data in this fashion will play a key role in a health system’s ability to transition from population health to a broader focus on overall patient experience.

The current emphasis on population health has required tremendous attention to patient data -- patients who represent relatively high risk and high cost (hypertension, heart disease, cancer, kidney disease) to ensure that preventive care keep them out of hospitals. As the cost/risk has shifted from insurers to providers, data analysis has been Job One for managed care.

Going forward, health systems have a chance to manage an expanded data set as a way to gain strategic advantage. Such advantages include gaining and retaining market share. Regional healthcare markets are a zero-sum game, so health systems that don’t maximize marketing performance will lose to competitors. A patient’s total lifetime value is $1.4 million and climbing, and referral “leakage” costs American hospital systems an estimated $150 billion per year.

Healthcare’s new consumer focus means improving the overall operational performance of a health system beyond the cost of delivering care. Data scientists: concentrate your analytics lenses on the overall value chain, starting with solving the challenge of how to ensure that each patient trying to find a doctor ends up in and remains in your health system’s provider network.

To play to win strategically, hospitals and healthcare systems alike must expand their data focus beyond population health. What’s the missing data piece? Managing provider data as part of a broader enterprise data model. Providers are, after all, are a health system’s “product” -- they are exactly what networks must effectively organize and market to target customers -- both patients and referring providers. As with any product, customers will have questions, so it’s important to have accurate and reliable information about providers.

Healthcare networks have invested tens or hundreds of millions (and in the case of some health systems, billions) of dollars to have strong patient data management infrastructure for their patients’ journeys. Several health care solution providers reliably deliver EHR applications to help manage a patient’s care journey. These systems have a robust patient data management model that supports patient enrollment, management, search (both for the patient and for patient history, records, or test results) and reporting.

Provider data management, however, remains hospitals’ and health systems’ Achilles’ heel. In addition to the business need becoming paramount, no robust enterprise operational data management system has ever existed for managing providers.

The good news is that health systems can now deploy an emerging set of purpose-built, provider-specific data platforms built specifically to manage the hundreds of data points about each provider in a health system.

The right data approach will ensure a real-time, always-up-to-date, 360 view of all network providers. This results in a better patient digital experience. Most health systems have multiple gaps in provider information requirements because their provider data is not based on a rich provider data model.

The impact is an endless stream of care coordination disconnects in patient scheduling, referrals, registration, care handoffs, and revenue cycle, not to mention shortfalls in revenue and market share growth, new patient visit growth, and utilization.

Spreadsheets and Content Management Systems Lack a Robust Provider Data Model

Despite the vital importance of accurate data about provider network participation, health systems rely on truly archaic tools -- either a trusty spreadsheet or an online content management system -- that highlight the need for new data models. This starts with having accurate, continuously updated data about which providers are in which networks.

  • Just how important is this objective? As any health system or employer will attest, inaccurate and incomplete provider information causes a variety of unfavorable business outcomes, including:
  • Administrative inefficiency created by multiple (and sometimes overlapping) teams continuously researching providers to determine their current network affiliations
  • Delays in payment due to inaccurate network-related provider information
  • Gaps in network coverage and adequacy by not having visibility into providers’ specialties and subspecialties, which leads to imperfect provider targeting and recruiting
  • Reduced in-network referrals and utilization (i.e., if PCPs don’t know which specialists are in or out of the patient’s network, network leakage will continue to occur), resulting in higher costs

High-quality provider information helps a network’s patients receive a clean bill of health, which, for narrow networks, ensures a clean bill of financial health.

Maturing the Healthcare Data Management Approach

Healthcare had to play catch up to big data and now needs to bolster the industry’s shift to value-based care with an even more data-management-centric approach that focuses on the overall healthcare value chain and the patient experience. It’s no longer just about population health -- health systems must now deploy data strategies that scale to the enterprise level and span the end-to-end experience of all patients.

This is a big shift, one that requires an expanded data focus by the healthcare industry. In 2019, healthcare will grow from big data to its more mature data management approach.

About the Author

Thomas White is the CEO and founder of Phynd.

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