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Why payers need top-notch digital data management


The healthcare industry is faced with a tricky challenge ahead: how to deliver better care to more patients, on a personal level but with lower cost. There have been a number of changes in healthcare in the past two decades, and while change has long been a constant, it has greatly accelerated in the past few years. With the advancement of technology, consumer expectations have increased in healthcare, a number of organizations are undertaking digital transformation and automation, and value-based care is being widely embraced.

For payers, the advancement of value-based healthcare is a nudge for them to interact directly with their consumers. This shift is encouraging payers to engage consumers and help them make better healthcare decisions. Much like in other sectors, such as retail, the vision remains the same: to make sure consumers receive a seamless experience, efficiently. However, this vision rests on good data. In sectors such as retail, data flows digitally in a highly streamlined way, is processed almost automatically to deliver actionable insights, which in turn helps the organizations achieve their goals.

Payers, unfortunately, are still far from achieving this goal. Payer organizations are still knee-deep in paper-driven processes and for a significant percentage of processes, paper is still the primary means of documentation. While payers gather a lot of data, it being on paper makes it difficult for faster, digital data processing and management. Additionally, paper-based data makes it more difficult to gain insights from advanced analytics.

Why is it difficult to eliminate paper-based processes?
While digital systems are becoming more prevalent and offer several advantages, it is not a surprise that payers are rooted in a paper-based world. Given the advantages of digitization in healthcare, many payers are starting to find ways to transform their processes, but it has been hindered by a variety of reasons.

Primarily, digitization becomes difficult due to the ecosystem in which payers operate. It requires building and implementing new technology, integrating it with the existing organizational technology and implementing complex changes in workflows. This requires a great deal of investment as well as changes in processes, and at times, may strike the fear of job losses.

Outside the organization, the healthcare ecosystem comprises of providers, payers, federal agencies, partners, consumers, and vendors. Getting all these stakeholders to go fully digital simultaneously requires comprehensive transformation and considerable switching costs.

Second, the privacy and security rules governing data processing and exchange make it difficult for eliminating paper-based processes. Digitization can result in cyberattacks or loss of sensitive data- which is rarely a risk with paper and understandable cause for worry.

Heavy reliance on paper not just slows an organization down, but can also be incredibly expensive. Additionally, providing healthcare consumers with a seamless experience of care will require a holistic view of all touchpoints, which is impossible to track on paper. However, digital transformation will not happen overnight and payers need to find better ways to handle paper while transitioning to a paperless, digital future.

A hybrid digital-paper data management system
Effectively merging digital and traditional systems of managing data is crucial because data is at the core of payer service- to provide patient-centered care- and it resides mostly in a paper form. But leveraging digital processes such as data analytics and automation is important to achieve the goal of patient-centered care and the lack of access to digital data becomes a critical challenge.

The first task for any payer undertaking this transformation is to put together the incoming information on paper in a structured, digital manner. This paper can be scanned into a digital form, with relevant information being extracted and utilized. Raw data from paper needs to be integrated with incoming data from other disparate sources to create unique, longitudinal records specific to each consumer. Such longitudinal records can provide a 360-degree view of the consumer’s interactions across all touchpoints in the network – and on a single platform, will be accessible in real-time.  Additionally, paper and digital information can act as backups to each other if and when there is a need.

Second, this digital data needs to be processed efficiently. By putting advanced analytics and automated workflows in place, payers can speed up their operations efficiently while eliminating redundant processes. Consumers won’t be asked for the same information multiple times, the amount of duplicate data can be reduced and executives can identify growth opportunities in their network easily. The digitized information can also help payers limit erroneous data and operational inefficiencies in their organizations.

From here, actionable insights can be shared with stakeholders efficiently over digital channels. However, large amounts of information can pose significant security challenges if not handled correctly. End-to-end security and confidentiality are important to consider, and these channels need to be compliant with data sharing regulations and limited authorized user access. Another important consideration is to make sure that relevant data reaches the right person at the right time, which makes real-time interoperability essential as well.

The do’s and don’ts of establishing digital data management

  1. Don’t assume that entire paper-based infrastructure can be rapidly migrated to digital channels. It’s going to be incremental as paper is well-established in payer organizations.
  2. Consider the investment strategy required to implement a migration strategy and build a system that can withstand the advancements in technology and is scalable to incorporate new changes.
  3. Don’t overlook analytic capabilities. With healthcare technology moving rapidly towards artificial intelligence (AI), advanced analytics are going to be essential as AI rests on good insights.
  4. Establish consistent goals to monitor the success of the digitization strategy and make sure the organization’s investments are directed towards features that deliver the most value to the overall organizational goals.
  5. Involve the end-users of these systems in the planning and implementation phase to make sure the manual workload will be reduced, rather than the other way round.

Payers, like retailers and other consumer-centric businesses, need to prepare for a future where they can meet the needs of patients more conveniently and efficiently. As such, digital data management is an essential component of that strategy. Strategic decisions payers make today will determine how ready they will be for a future where patients expect their healthcare to be as seamless as online shopping.

Photo: LeoWolfert, Getty Images

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