Maximizing Outcomes for Patients, Payers and Providers with Data Accuracy and Efficiency

Emphasizing data efficiencies and quality will benefit payers and providers — and patients.

The intricacies of data are both an opportunity and challenge for the healthcare ecosystem. While having accurate data is one piece of the puzzle, providers and payers must also have the right tools, processes and expertise to analyze, secure and implement this data effectively. In addition to accurate data, data sharing can also be a hurdle. Per a Center for Connected Medicine and HIMSS Media survey, almost one-third of hospitals indicate their data-sharing efforts are insufficient, even within their own organizations, and fewer than 4 in 10 say they’re successfully sharing data with other health systems.

With these challenges in mind, paired with the ongoing economic, operational and care delivery challenges posed by the COVID-19 pandemic, what can providers and payers do to minimize financial risk, increase patient and member engagement, and ensure cost efficiencies?

A recent TransUnion Healthcare report, Healthcare Data Priorities: Insights From Providers and Payers, explores data utilization patterns and organizational priorities for leaders within healthcare provider and payers. The report details the gaps and opportunities that exist in access to accurate and reliable data, as well as resources and expertise, which can detrimentally impact care quality and cost outcomes for all stakeholders.

Some of the report’s key takeaways and strategies for the healthcare industry include:

1. Providers and payers lack confidence in the accuracy of their patient/member demographic information

According to the report, only 37% of payers and 58% of healthcare providers are very confident their member/patient demographic information is correct. This percentage is concerning as inaccurate data can lead to further challenges in payment, patient/member experiences and care outcomes.

Inaccurate data can also cause a disconnect in the relationship between provider, patient, and payer. In a recent TransUnion Healthcare case study, 132,000 records were reviewed for patient/member contact information. Across best contact points for address, phone and email, 60%-263% additional contacts were uncovered across these categories. This is an example of how data inaccuracies may be quietly lurking in the background at the expense of the best clinical and financial outcomes for providers and payers.

Quality data also delivers a more comprehensive view of each individual’s unique situation, enabling providers and payers to better manage payment risk and spot opportunities to provide more individualized care.

2. Data priorities for healthcare leaders include improving the patient experience and data efficiencies.

In today’s healthcare environment, gaining a holistic picture of a patient’s social, clinical and financial situation is absolutely integral to addressing healthcare challenges for providers and payers. It’s critical to have access to comprehensive, validated data in order to most effectively serve both patients and members.

According to the study, 63% of providers and 53% of payers ranked improving data efficiencies among their top three priorities. And 51% of providers and payers ranked positive patient or member experiences among their top three.

Data helps the healthcare system identify trends in patient care, address equitable and timely care delivery shortfalls, and determine affordability gaps. All of this ultimately helps minimize financial risk for providers and payers. Taking the time to ensure that data — such as patient/member contact information —- is in fact correct, can ensure timely communications and enhance engagement for the payers’ members they serve.

An important success factor for achieving the best patient/member, provider and payer outcomes involves building trust. Data can help inform more personalized, individualized care, coverage, and payment which can lead to enhanced loyalty. This is especially important as the industry recovers and rebuilds from the pandemic.

Putting an emphasis on data efficiencies to improve patient/member engagement, while also finding ways to help reduce their costs to obtain quality care, will lead to long-term benefits for payers and providers. It can also make all the difference when it comes to seeing patient visits return to pre-pandemic levels. The new normal will consider the patient, payer, and provider as equally important stakeholders in the process – and having accurate, actionable datasets will ensure desirable outcomes for all parties.

Jim Bohnsack is senior vice president and chief strategy officer at TransUnion Healthcare.