Value-based care requires a holistic view
Although many health plans have implemented a helpful level of automation, as well as some healthcare analytics tools, many are finding that they’re still unable to quickly access a comprehensive view of their overall business, members’ health, providers’ performance and treatment outcomes. Ready access to such a holistic view is the only sustainable way to deliver value-based care, and it requires fully automated processes that provide analytics-enabled, actionable reporting.
Ensuring that the correct report is sent to the appropriate person is only possible with:
- Integration across systems and channels,
- Identification of bottleneck processes,
- Determination of processes that can be successfully automated,
- Implementation of robotic automation analysis, which can identify key trends and pinpoint members who need medical intervention.
A roadmap to managing the new data demands
Every health plan knows that establishing a data strategy that clearly defines the useful data an organization will use and aligning that strategy to the plan’s organizational strategy helps retain the best healthcare providers, control costs, increase member satisfaction and grow the business.
But the million-dollar question remains: where to begin? The best place to start is at the point of most significant pain, and the first thing to do is examine all processes, so the ones that work can be accurately identified — as well as those that don’t. That sounds simple enough. The problem is that many CIOs are concerned with processes and tools without necessarily viewing the entire supply chain of data. Most IT shops think in terms of “projects,” whereas data is a never-ending “flow.”
We work with many health plan organizations now hiring Chief Data Officers who understand that data is not a one-and-done concept. Instead, they have realized it is a never-ending cascade of information, and one of the most important tasks is to identify useless data that is redundant, obsolete or trivial (ROT). Eliminating ROT sets the stage for faster decisions based on new clarity.
Unfortunately, executives and lower ranks alike often shrink from discussions about data and analytics simply because they feel overwhelmed. While they certainly recognize the need for timely, reliable data, putting their hands on it is still as complex as it’s always been. In recent years and since the pandemic, there has been a massive surge of data — from IoT, Web, sentiment analysis, video, and more — and its sheer volume can be overpowering.
The other big issue we see is that health plans are struggling with data that resides in separate silos. This is especially true for those that have weathered mergers and acquisitions or consolidations. In addition, evolving regulatory compliance requirements, claims processing complexities, and other factors have intensified these data challenges and left critical technology updates in the dust. Yet, these crucial updates are the very key to integrating the disparate systems and providing the comprehensive window they so drastically need.
It is not enough to gain access to the staggering amount of available data; health plans must also understand it to take appropriate action. Actionable data puts the human factor in decision-making; after all, humans have common sense, whereas computers do not. Human users must know where and when the data originated and whether a medical decision was based on human knowledge or an algorithm before using data to make an informed treatment decision. This demands a keen awareness of where the data is collected so that the right data can be directed to the right person.
Additionally, health plans today serve members who value human interaction. How well a plan can deliver on its “customer experience” promise determines whether it will retain existing members and attract new ones. Thus, interactions with chatbots and virtual assistants must prove that the plan is empathetic to the members’ concerns. The ability to recognize the tone of voice or facial expression conveys an impression of empathy, and this is every bit as vital to the customer experience as accurate, timely medical information. However, it is a different kind of data, and the plan must manage it. Unfortunately, many plans have taken hesitant steps in this direction in recent years.
A global pandemic accelerates rapid adoption
Enter the novel coronavirus and the healthcare community’s urgent need for reliable data: with data and analytics in place inside integrated, plan-wide systems, critical activities — such as treatment tracking and contact tracing, as well as complex analysis that enables predictions regarding future COVID-19 hot spots — are at management’s fingertips.
But the truth is that many health plans have not yet achieved this because their raw data still resides in different systems. Virtual visits enable automated intake interviews, and telemedicine now makes possible doctor/patient interactions that have never been needed before. Although the technology and capabilities have been available for some time, it is the pandemic driving adoption. Plans recognize — belatedly, in some instances — that they must be able to keep up with patients’ expectations. But since many have no standard data collection process, the reliability of the data used to make critical healthcare decisions is questionable. In the past six or seven months, many plans have felt extraordinary pressure to quickly improve their interactions with their healthcare providers and operate more seamlessly with their members.
COVID-19 has also revealed many patients’ concerns about their electronic medical records; they want to know what their plan knows about their history. In addition, they are concerned about errors that could cause them to be denied coverage. From the health plan perspective, members’ health records must be managed effectively to retain members. Data and analytics help make medical records more shareable among plans, providers and patients. In addition, the current pandemic has forced health plans to understand the importance of keeping “people” at the center of the equation, and data and analytics can empower them to achieve this.
NTT DATA helps health plans master a must-have asset
NTT DATA focuses on bringing health plans’ — as well as their constituents’ — data together, so they can understand it and use it more effectively. Our deep industry expertise and data and analytics know-how help ensure that plans can govern the data they have to foster collaboration among the plan, providers, brokers, and members. We have great examples of how we have used data and automation to reduce costs; increase profits, and retain members while growing the business. We can share these examples, help identify the older technologies holding your organization back and help upgrade or replace them to create a clear path for maximizing the value of data.
Fecha de publicación: 09/07/2021