Monday, 08 February 2016 03:15

Who’s on First?

Written by


With the recent announcement that 477 accountable care organizations (ACOs) have signed up for the Medicare ACO program, with over 8.9 million beneficiaries being serviced, the healthcare industry’s interest in being paid for improving quality and lowering risk is at an all-time high. As stated in past VBPmonitor articles I have authored, any movement toward value-based revenue must rely on a firm foundation of information to monitor, manage, and direct action. This is easier said than done, and it continues to challenge many healthcare companies. A common excuse for non-action is to claim that the data is inaccurate, which often causes misdirection and stagnation. At all costs, you want to prevent organizational chaos and avoid anything resembling that famous Abbott and Costello skit, “Who’s on First,” when referring to your value-based reporting.

As organizations strive to expand their business intelligence capabilities, they must rely on additional sources of member/patient information to best manage quality, cost, and experience. Information, often coming from disparate sources, now must be captured and leveraged to address not only individuals, but entire populations of individuals. Information sources have expanded to include:

  • Electronic medical/health record systems, including both inpatient and ambulatory activity
  • Home healthcare and long-term care systems
  • Practice management systems
  • Health information exchanges
  • Insurance marketplaces
  • Self-report data such as health risk assessments and personal preferences
  • Claims and enrollment systems
  • Care management systems
  • Social media
  • Biometrics and wearables

To ensure that data can be converted into information that can be studied and leveraged to manage outcomes, costs, and experience, it must be fortified. Think of the ramifications if data is incomplete and inaccurate. For example, imagine calling a patient regarding a recent emergency room encounter only to find out that they never went. Or envision panel reporting to a physician, citing patients they have never seen, or trying to instill customer loyalty with a friendly “happy birthday” phone call to discover the birthday was 12 weeks ago.

Poorly managed data can severely damage an organization’s brand and reputation. Data quality is often overlooked and/or compromised when organizations attempt to build or expand their data warehouses. The oft-heard notion that “managing data quality will add too much time and cost to the project” is a foolish and shortsighted stance. However, as healthcare organizations recognize the importance of business intelligence and continue increasing their dependence on it, they are learning to embrace data governance, data quality, and master data management as key elements of a successful and reliable business intelligence foundation.

Governance is the human aspect of managing data. A data governance framework defines the orchestration of people, processes, and technology that ensure the accuracy, timeliness, and effective use of data across the organization. The governance framework involves the following components:

  • Organization structure, roles, and responsibilities
  • Data strategy to increase the value, availability, and reliability of data
  • Communication plan involving all stakeholders to promote data sharing and acceptance
  • Data policies and procedures to measure and monitor data quality, ensure adherence to business rules, compliance with laws and regulations, and the protection of data assets
  • Data standards to promote data consistency across the organization

As part of data governance, data quality tactics must be employed to ensure that data loaded and/or derived is accurate, thus building stakeholder trust. A successful data quality program will entail:

  • Creation of data quality rules, including definitions, constraints, and calculations
  • Creation of a data glossary, including terms, rules, tagging, and ownership
  • Implementation of data quality and monitoring, including deploying rules and automation, data validation, and ensuring business engagement and adoption
  • Expanded auditing and controls, including the ongoing process, metrics, and reporting

Prev Next »

Last modified on Tuesday, 09 February 2016 04:44

As Senior Vice President of Healthcare Solutions, Jim is responsible for business and financial growth, new product/service development, strategic planning, business partnerships, and staff development across our healthcare practices.  Prior to joining HighPoint, Jim spent 14 years as CIO and VP of Enterprise Operations at Priority Health. He has also held senior positions as JS Advisory Services, Ernst & Young, and Henry Ford Health System.