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Viewpoint: Healthier use of healthcare data

Tim SpaethBy Tim Spaeth

Back in the days before the data deluge, there were clear and distinct roles regarding IT and Finance in the healthcare industry. When patient and payer medical information was captured on multipage paper documents attached to a clipboard, it was easy to manage the data, however ineffectively. But those days are long gone. Healthcare organizations now need to take a serious look at the potential business value of developing a strategic partnership with IT in order to create analytic solutions that deliver quantifiable results.

Traditionally, the IT team has focused on maintaining data security, reducing risk and managing infrastructure uptime. But what keeps the CFO up at night is how to run the company more effectively to generate revenue, lower costs and improve productivity. Today, the opportunity exists to create a dynamic partnership that helps both organizations achieve success and drive positive business results.

To the IT team, data is something that needs to be stored and managed and protected. They tend to view it from a very transactional perspective, focusing on proper formatting and whether it has been organized into the right categories. They have little or no big picture perspective on how it can be used to improve billing accuracy or reduce costs and increase profitability. That’s not their job.

Healthcare data

Healthcare organizations need to take a serious look at the potential business value of developing a strategic partnership with IT.
Photo Courtesy of 123rf.com | © Takashi Honma

On the other hand, the CFO wants to know where there are potential sources of revenue and ways to drive cost savings. Current analytics tools have the ability to answer these and many other types of data-related questions, but solving the problem requires aligning two historically separate agendas.

The IT team wants to run analytics in as risk-free and efficient a manner as possible and often without the proper subject matter expertise regarding what data to capture and measure. Finance, on the other hand, doesn’t clearly understand the capabilities IT has that could drive new insights based on the accessible data and, as a result, finds itself at the mercy of IT to develop and build models to answer these questions.

Take for example the process surrounding claim submissions to the government that eventually results in payment to a health plan. A typical plan sends millions if not billions of transactions each year to the government. Viewed from a strictly IT perspective, the primary goal is to get the data into the proper format and submit it. This is, of course, required in every situation and unfortunately for many IT departments, they feel that their job stops there.

However, from the perspective of the Finance team, accurate and consistent data submission is the expectation, the table stakes. What they really want to know is whether all the data made it through, were there any errors, and if yes, what were those errors? And ultimately, who can fix those errors? Very often, it’s not in fact IT since these kinds of errors are related to other stakeholders and include things such as enrollment information, provider-specific data or diagnosis codes.

But with access to this kind of data, the potential for cost savings and improved productivity are enormous. Using analytics, Finance can quickly identify and prioritize errors, ignoring the unimportant ones while focusing on those that have the largest business impact. These include ones related to providers with submission issues or outliers with potential compliance problems. This kind of insight leads directly to identifying potential fraud, waste and abuse areas, all things that IT is not typically concerned with.

While the deluge of data has become a challenge that impacts every aspect of the healthcare industry, it also represents a tremendous opportunity for IT and Finance to collaborate and create measurable value. Companies who take advantage of this new partnership will quickly move ahead of the competition and see significant business benefit.

Tim Spaeth, senior vice president, payer solutions, leads Episource’s RAPS/EDPS submissions and analytics services, directs the company’s risk adjustment consulting practice, and provides strategy around analytics for both Medicare and ACA. He has more than 10 years of experience leading risk adjustment projects and revenue analyses in the healthcare industry, as well as 20+ years of experience in finance.

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