Value-based care requires a longitudinal view of the patient record from different encounters and disparate data sources. Due to their holistic view of a patient’s care across providers, lab visits, and prescriptions, health plans are uniquely positioned to create the most comprehensive window into the patient’s health. Data is the foundation for complete care insights, and having the most complete, accurate, clinically-tuned data across care moments enables providers and health plans to power better health for patients.
There are 186 different ways to code a condition or diagnosis. This is an astounding amount of information for health plans to navigate, particularly given the variety of inputs from providers, labs, vendors, and other sources. We can no longer remain siloed, but instead must derive a common meaning from these insights that creates an authentic, holistic picture of a patient. By giving health plans a common platform that offers intuitive data management tools and trusted standards-based data models we ensure data consistency and quality across all individual-to-individual care moments and can deliver system-wide benefits and cost-efficiencies.
Streamlining and accelerating data governance
Health plans are expected to pay out millions of claims totaling billions of dollars each year, but must have tools in place to manage enterprise codes sets to define rules for payment of claims, exclusions and benefits for their network. Enterprise code set management is a complex undertaking for many organizations due to the sheer volume of codes that must be managed: ICD-10 includes over 70,000 codes and CPT® over 10,000.
The solution? A strategic, automated data governance solution. Using a single platform to validate and process code updates and review changes, one health plan saw a 75% improvement in efficiency when updating code sets and reduced teams involved from 12 to 3. This led to a 90%+ time reduction to process updates, cutting processing time from 6-8 weeks to just a few hours.