How to Drive Value-based Care with Modern Data Management

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (World Health Organization, 1948). The pace of change in healthcare is accelerating with growing demands from patients, regulators and technology optimists. A paradigm shift in care delivery along with the new pay-for-performance model requires healthcare organizations to modernize their data management. The ability to understand the complex and dynamic relationships among providers, organizations, patients, pharma, payers, locations and health plans is critical for driving the right care.

Reliable data is at the heart of driving digital transformation in healthcare. The quality of data impacts every decision made along the patient’s healthcare journey. When data about patients, physicians, employees, caregivers and care locations is incomplete and fragmented, it is unthinkable to manage the relationships among all these participants of the healthcare ecosystem, and derive meaningful insights from their day-to-day interactions. Moreover, with ever-changing regulatory requirements, newer treatment discoveries and personalized care models, it is becoming far more challenging to keep healthcare data clean, complete and current. All of these factors lead to stale data and information latency, directly impacting patients’ lives and providers’ business sustainability.

Meeting today’s goals of patient-centricity, lowering readmission rates, and ensuring adherence to medication requires complete patient understanding. A Modern Data Management Platform helps blend all patient profile information, including EHR/EMR, lab results, omnichannel interactions and transaction and claims and reimbursement information into a single, easy to use data-driven application, helping organizations to provide better and personalized care. Not only does it help improve provider satisfaction by streamlining the claims payment process and identifying fraudulent claims, but it also enables segmentation of members and predictive modeling for personalized care and effective cost management. Moreover, its underlying graph technology provides new insights into patient’s support structure by unfolding patient’s relationships with caregivers, payers and family members.

Maintaining patient trust is the cornerstone for building a successful healthcare ecosystem. As patient privacy and compliance are of paramount concern, healthcare organizations need comprehensive auditing and tracking features to guarantee Health Insurance Portability and Accountability Act (HIPAA) compliance. Complete lineage and historical trail for any data matched, merged, or updated is required. A fine-grained clickstream analysis can be used to alert the admin about abnormal data viewing patterns by application users for possible information breach or theft. Thus, with the proper data protection strategies in place, providers can share sensitive patient data securely, within and across the organization.

Healthcare organizations are responsible for maintaining a patient-centric focus that ensures adherence to medication and treatment, timely and continued patient engagement to provide relevant health information and regular internal reporting on the quality and cost of the healthcare delivered. To make sure these objectives are met, reliable data and up-to-date information, through a Modern Data Management Platform, must be available at the fingertips of all the concerned stakeholders via data-driven applications, in a compliant fashion. Only then, will they be able to translate the vast volumes of data into a meaningful information asset that can be used to drive quality patient care.

All in all, a Modern Data Management Platform lays the foundation for achieving: Right Living, where patients are encouraged to play an active role in their own health by making the right choices about their lifestyle; Right Care, where patients receive the most timely, appropriate treatment available; Right Provider, where they have strong performance records and can achieve the best outcomes; Right Value, where providers and payers continually look for ways to improve value, while improving healthcare quality; and Right Innovation, where all stakeholders focus on identifying new therapies and approaches to healthcare delivery.