Diagnosis: Data is King
Insurance Networking News, June 1, 2009
A mid the demands of the new administration's health care reforms, stakeholders from all segments of the health care marketplace are focusing efforts anew on creating business and technology strategies that will keep them viable. This is especially true for health insurers, now revisiting how they regard, organize, access, use and transmit data in and out of a growing health care universe.
Advertisement
And with patient data being used for any number of purposes - from claims, payment or operational functions, to clinical quality reporting and evidence-based decision support - its role cannot be overstated.
"There are big changes coming in the health industry," says Matthew Josefowicz, insurance practice director at New York-based Novarica. "All participating in the market feel something big will happen in the next 12 to 18 months, whether it comes from economic pressure or government action. It's important for insurers to have their own internal data house in order, and become more aware of the changing nature of the external data landscape."
Whether insurers have their data houses in order remains a question. A survey conducted in March of health insurers by Novarica on behalf of three SourceMedia publications, Insurance Networking News, Information Management and Health Data Management, yielded perplexing results. The survey, which targeted 27 unique health insurers representing companies of all sizes, sought to uncover the current state of data strategies among health insurers.
Not surprisingly, insurers of all sizes are making data a priority in the IT shop, with more than 23% of respondents stating they spend 35% or more of their IT dollars on data initiatives.
It follows that the majority of respondents also reported having "adequate capabilities" in data repository for use with customer data and claims, and for predictive analytics for claims and underwriting.
"Health insurers are adept at using data expertly to manage claims, and we are seeing a wide range of capabilities in these other areas," says Josefowicz. "Not surprisingly, where insurers are most advanced is in their data repository capabilities, their investment in data warehousing, and their ability to build out repositories and report out of that."
A SURPRISING DEFICIENCY
What was surprising was the respondents' answers to whether they felt they had adequate capabilities in master data management. Here, close to half answered "adequate capabilities," yet an equal number answered "limited capabilities, but no planned investments."
"There is a big split between companies that put master data management programs in place, and those that are waiting to float it to top of their agenda," notes Josefowicz, "especially as the amount of data increases exponentially, such as with pharmacy and electronic health records (EHRs)."
Josefowicz points to another revelation of the survey: Close to half of the respondents noted that they did not have an enterprise data model, and a third of those said they had no short-term plans to invest in one.
"We know that the improvement of data management processes have a positive impact on customer service, claims and underwriting, but it should be an enterprise effort," he says. "Having an enterprise data model is critical to achieving this."
Remarkably, when respondents were asked whether they had a center of excellence or formalized data governance program, 37% reported having "limited capabilities, but no planned investments."
To be fair, notes Josefowicz, some respondents are simply conducting business the way most do in a down economy-by dealing with a limited IT budget, therefore making data a lower priority.
"It's important to note that these results are more reflective of business practices rather than IT practices," he says. "It's about the way you approach your management of data, how health insurers structure themselves around the importance of data."
Even so, these findings cast a pall over plans to quickly digitize the health care system.
For more information on related topics, visit the following channels:
