Health plans are constantly looking for new ways to reduce operational costs and improve efficiencies, but many of the issues that have plagued health plans for decades come down to one thing: the inability to get accurate, dependable, and transparent data.
Why is that? When it comes to healthcare data – it is everywhere, and it comes in many different forms, such as claims data, clinical content, edits, pricers, contracts, audits, and more unstructured data. Medicare is constantly evolving its policies, but the pace of change has dramatically increased in the past few years as government programs move toward value-based care payment models. Each managed care organization running state Medicaid programs has its own set of rules, waiver programs, and special pricing, as states attempt to meet the needs of their most vulnerable populations and the demands of the growing number of lives it must cover. And every entity updates its data set, pricing, and regulations at different intervals.
To further compound the problem, many health plans remain tethered to their legacy systems with no centralized way to make sense of the multitude of different data sources and formats; the human resources required to keep track of all these moving parts drag at profitability and stifles innovation.
To remain competitive, health plans need a modernized, comprehensive solution that can easily integrate with their entire ecosystem to orchestrate accurate data into every process and decision.
Now more than ever, payers need to make data accuracy a top priority. The trickle-down effect can be huge. Let’s take a look at the true cost of bad data:
1. Extreme inefficiencies: Inaccuracies due to disjointed data processes result in time wasted on rework and over-/under-payment recovery efforts. The cost to support these efforts is substantial.
2. Inability to adapt: More than ever, the continuously evolving healthcare landscape requires agile health plans. Lack of data transparency slows down health plans and prevents rapid responses to market conditions, like rising consumer expectations, ongoing legislative fluctuations, and new competitive entrants.
3. Provider burnout: A health plan’s legacy technology environment leads to poor processes, inaccuracies, and lack of transparency for providers to see and understand contracts. These gaps lead to administrative hardships and contribute to provider burnout.
4. Uniformed business decisions: Without complete data transparency, health plans may not fully understand the fiscal impact of an industry shift, such as a new CMS policy. This can lead to ill-informed decisions or even the inability to make decisions about reimbursement rates.
What Happens When We Get It Right?
While some vendor solutions claim to address these fundamental issues, their solutions are built on a legacy foundation, often designed for on-premise installations with additional, gap-filling solutions bolted on over the years through mergers and acquisitions. This perpetuates the current state of multiple instances with multiple update cycles and multiple data calls to claims systems.
However, some leading health plans are beginning to understand the value of addressing the root cause of data issues and favoring solutions designed to enable them to use their data as a strategic asset.
These solutions are designed specifically to empower payers by delivering:
- Cloud-supported infrastructure and single API
- Single update cycle
- Single call and single source for fee schedules and payment policies
- Single instance to connect with all claims systems
- Ability to automatically connect with third-party content within the same UI
Source is one such solution that challenges the status quo, giving payers more control over their payment integrity operations and greater transparency into their own data to orchestrate business decisions in ways that make sense to their unique challenges and operations.
If you are interested in learning how Source can help your organization reduce operational costs and improve efficiencies through better data, visit us at www.healthedge.com or email [email protected].
Check out our latest white paper and see 314 Billion Reasons Why Better Data Wins.