Health Plans Are Managing More Data Than Ever Before. How to Ensure It’s Usable.


Health plans need to consider regulations and keep healthcare data secure to take full advantage of its enormous potential to broaden and reshape timely, effective delivery of care.

From electronic health records to wearable devices, there has never been more healthcare data generated – and the amount of data pouring in is only growing. Data permeates every aspect of the healthcare system, carrying with it rich insights into a patient’s health and well-being that can inform a multitude of care scenarios. Digital health’s meteoric rise is a key driver of the growth in healthcare data with tools like telehealth and remote monitoring playing a major role in the increase in information generated.

Adam Sabloff

Adam Sabloff

Although this growth in data collection has benefits for most sectors of the healthcare system, payers, especially, bear the bulk of the data burden. These organizations need to stay on top of a few key aspects related to data management now to ensure they are well prepared for the future.

What should health plans focus on to ensure data is usable and maximize its value?

The first consideration is regulations. Thanks to policy implementations at the federal level, longstanding barriers to data sharing that have been plaguing the industry are finally being prioritized and defined. CMS' Interoperability and Patient Access final rule is one of the most recent examples of these changes. Under this guidance, payers and providers are now required to remove the industry silos that prevent patient data exchange across the care continuum. This is a win for consumers as it will enable more seamless information sharing between provider services and better patient experiences. However, it is a potential challenge for payer systems that will now need to comply with standardized data sharing requirements. Health plans should seek out a trusted partner to help aggregate and manage their vast quantities of information, which can reduce the burden on keeping the backend systems up to date.

Another major consideration is data security. Health data by nature is highly sensitive. With the dramatic increase in data breaches and ransomware attacks the penalties for not building out effective controls are dangerously high. Governments, employers and patients are entrusting their most proprietary information to payers to control, monitor and manage access. Payers must do everything they can not to lose that trust. Building robust cybersecurity protocols and ensuring partner organizations have similarly strict standards can help ensure this information remains in safe hands. Third-party verification organizations like HITRUST® set rigorous industry standards for security and signify to consumers that an organization takes security and privacy seriously.

Why is healthcare data so important? As the industry shifts towards a value-based care future, it will require a more detailed, 360-degree view of each patient with more data sources than ever before. When we have both accessible and comprehensive data, we can unlock insights that inform critical and preventive care, reducing the likelihood of costly emergency medical scenarios. Data can enable payers and providers to detect and address diseases and the risk factors for them across populations earlier, and up-level the care that is provided. This means a decrease in heavy and recurrent utilizations and less strain on hospital systems, which are under more pressure day by day.

In addition, effective data management is a principal facilitator of programs to address social determinants of health and ensure equitable care to individuals, especially the most vulnerable. Filling the gaps in care that exist due to these disparities requires access to real-time, comprehensive data that accounts for social factors as well as behavioral and clinical data. Without it, health care providers cannot have a complete picture of their patients or take fully informed, actionable steps to intervene.

Data is irreversibly shaping the future of care delivery. By focusing on building out and safeguarding the healthcare data that is generated, we can put ourselves on a clear path to a more proactive-driven healthcare environment that costs less while providing better care.

Adam Sabloff is founder and CEO of VirtualHealth.

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