25 December 2019 | Daniel Piekarz
360-Degree Patient View for Healthcare Payer Organizations
For years, data warehouses have sat, stuffed full of data that no one could usefully access. With the advent of data lakes, all this is changing.
Over the past decade, the entire focus of healthcare payer organizations has shifted away from simply paying claims towards aiming to act as transformational leaders in healthcare. At the core of this groundbreaking shift is a new understanding that the healthier the population you manage is, the lower healthcare spending becomes. This has led to a new strategy aimed at improving health outcomes for patients.
Patients respond in unique and individual ways to the same care model, based on a variety of factors including race, genetic makeup, family history and others. So in order to improve outcomes, care provided must be individualized and specific to each patient. To make it possible to serve each patient effectively, payers need to understand each patient. Consequently, they must be able to collect and analyze all the data available from myriad sources efficiently and on an as-needed basis. This data enables greater understanding of patient populations, which are a higher risk for which diseases and therefore need pre-emptive clinical outreach, as well as assessment of hospital re-admission risks, prediction of medical loss ratios (MLRs) and the delivery of other valuable business insights.
Payer organizations already collect and store large quantities of patient data. Sources include electronic health records (EHRs); prescriptions; lab records; admissions and discharge records; ambulatory and ER data; and handwritten notes.
The challenge payers face is that this data is not transformed quickly into meaningful insights that can be used across their organizations as needed. By the time data can be transformed into meaningful insights, it is already outdated and irrelevant. Data is collected and stored in a variety of complex payer systems but often becomes stale or is overlooked in a mismatch between systems. There is no reliable single repository.
Traditional data warehouses are simply collections of structured data. Payers have heavily invested in creating and maintaining these data warehouse, but are waking up to the fact that it is virtually impossible to create a system which presents an on-demand “view” with a transactional nature when handling both structured and unstructured data together.
This ongoing industry issue, is, however, now entirely solvable. Enter, into the picture, data lakes that can contain structured and unstructured data, eliminating entirely the need for a traditional data warehousing approach. Payers can now deploy data lakes, collect all the data contained and build analytics solutions on top of the lake. These systems can extrapolate comprehensive patient “views” that are accurate, complete, unique to the patient. These provider 360 views can be generated on-demand by any consumer, such as a customer service operative, a clinician, a marketing manager and so on.
Along with related insights and data visualization 360 views can be shared internally with consumer organizations as well as external organizations. Doctors and hospitals can use them to predict re-admission risk based upon comprehensive medical histories and care plans, rather than relying simply on EHR data. The views can also be combined with genetic data to give greater understanding of drug interactions and metabolization to help determine Rx pathways. Another use is the integration with social and economic data for population health management and risk stratification.
Apart from the obvious advantages of greater patient understanding that investing in a data lake imparts, there are other strategic benefits. Once the data lake has been set up, and data intake and analysis has become the norm, it can be used for additional purposes, using the same data visualization and analysis platform. Once the correct training has taken place, IT burdens are significantly reduced to cover just operations and maintenance, time-to-market is also reduced, and the savvy business user can build a truly customized solution with very limited reliance on IT resources.
The data lake “view” system also brings rewards that can generate a healthy return on investment. Fraud, waste and abuse can be detected and prevented. Provider 360 views include onboarding, maintenance and reimbursement data, reducing costs across these areas. Automated plan monitoring enable real-time insights into how plans are performing both in risk and utilization, based upon utilization and clinical data.
For years, the data has existed. With the 360 view, it can work to its full capacity, bringing down costs for all and taking healthcare to a new level of accuracy and efficiency.
Click here to setup a call with Daniel Piekarz, SVP, Healthcare & Life Sciences Practice Leader at DataArt to discuss in more detail how our team can help with data warehousing; fraud, waste and abuse detection and prevention.