The cost-benefit of data quality and strategy in healthcare

Evidence-based strategies prevent costly errors

Payers are deepening their use of evidence-based medicine (EBM) within tools and content to streamline operations and improve decision-making of multiple stakeholders. Tools like UpToDate® decision support and Medi-Span® drug data solutions integrate clinical and pharmaceutical data, aligning decisions across not only medical and drug benefits, but also with the resources physicians and pharmacists consult  at the point of care. This alignment helps reduce costly errors, such as discrepancies in coverage determinations or inconsistent formulary applications. By relying on a unified evidence base, payers and pbms can focus on supporting timely, effective care while reducing denials and administrative abrasion.

Key benefits of aligning clinical content and data sources across a payer organization include:

• Operational cost reduction: Unified data systems help reduce discrepancies in medical and pharmacy decisions
• Improved member satisfaction: Alignment supports timely approvals and minimizes delays in member care
• Fewer appeals: Evidence-based frameworks streamline coverage decisions, reducing incorrect claim denials and appeals

Enhancing decision-making through data alignment

Alignment is at the heart of modern data management strategies, enabling payers and providers to break down silos between medical and drug benefits. By aligning data sources and inputs, healthcare organizations can access a more holistic view of member health, driving better care outcomes and achieving cost efficiency in healthcare.

When payer teams leverage consistent, evidence-based frameworks, they improve the ability to address complex issues such as chronic disease management and at-home infusions. UpToDate and Medi-Span foster this alignment by integrating evidence-based clinical and drug data into unified systems.

Key areas where data strategy frameworks add value include:

• Operational efficiency: Improved alignment helps reduce inefficiencies caused by siloed teams and conflicting information
• Personalized care: Integrated data allows for tailored interventions that target specific member needs, improving outcomes and satisfaction
• Cost reduction strategies: Streamlined processes and consistent, evidence-based decisions help reduce unnecessary administrative tasks, complications, and associated costs

By adopting aligned strategies and clinical content, payers and providers can drive member care initiatives is both effective and economically sustainable.

Long-term economic benefits of data investment

Investing in high-quality data and clinical content is not merely a short-term operational fix; it is a long-term strategy for economic sustainability. Improved data quality in healthcare practices can result in fewer errors, faster claims processing, and enhanced member satisfaction, all of which translate to financial stability.

Moreover, payer-provider partnerships supported by aligned data foster trust and decision-making in healthcare, ensuring that members receive appropriate and timely care.

By adopting a data strategy framework, healthcare organizations can address emerging challenges such as health equity and personalized medicine. Leveraging expert data helps design programs that are cost-effective and equitable, addressing the diverse needs of member populations.

The economic case for investing in superior data quality management models and strategies is clear. As healthcare continues to evolve, organizations that prioritize evidence-based content and data transparency strategies will lead the way in operational efficiency and member satisfaction. By evaluating and enhancing current practices, healthcare organizations can achieve significant healthcare cost savings, improve care outcomes, and position themselves for long-term success.

Learn more with our latest ebook, “Aligning Payer and Provider Strategies for Enhanced Member Experiences.”