Blog

Jan
18
ENTERPRISE DATA AND ANALYTICS (EDA) FOR HEALTH PLANS

What can EDA do?

EDA is the governed integration of disparate data collection applications, into a centralized “source of truth”, for enhancing business acumen to improve and optimize decisions and performance. EDA allows health plans to easily:

  • Analyze provider performance in order to optimize pay-for-performance

  • Evaluate treatment patterns across providers and better tailor care management program

  • Identify underlying opportunities for health education and intervention with high-risk members

Sustaining fixed EDA support and overhead costs can allow an organization to continue growth and improvement, thus providing an infinite return on investment (ROI).

Why do you need an EDA?

  • How are your patient outcomes improving?

  • Are you doing the same things but expecting different results?

  • Have your past investments become your “legacy” systems?

  • Are you experiencing rising costs, long revenue cycles, and bad debt?

  • Who are the health care provider/vendors that are performing well?

  • What lost economic opportunity (LEO) have you missed?

  • Are you maximizing your ROI?

If you answered yes to any of the above questions, then you need EDA to give you give the best assessment of you organization performance, so that you can make the best decision for your organization. Even the smallest improvement in everyday decision-making can improve corporate performance, member health, and profitability as the healthcare industry is transitioning to Evidence-Based Medicine (EBM), Pay for Performance (P4P), Diagnosis-Related Groups (DRG) and Consumer-Directed Health Plans (CDHP).

Today, many health care plans are struggling to make decisions without having access to all the information they need. The business and Information Technology departments are struggling to understand each other and connecting to corporate data sources are becoming too cumbersome. Even more challenging is obtaining external data sources, as data is found:

  • On the Internet

  • In customer relationship management (CRM) tools

  • Publications (documents) or Email

  • Excel/Access

  • In employee’s own experience (“Tribal” knowledge)

Health plans are inundated with information that impacts how decisions are made, and they are unable to harness the power of their own information.‚Äč Existing reporting provides siloed views of an organization, and leadership is forced to make decisions through their “legacy” analytics.

The problem with legacy analytics is that it addresses only a fraction of the information we use in decision-making. For one thing, these traditional systems are limited to the enterprise resource planning system, the data warehouse, or other transactional systems already in place. For another, they are often inflexible, making us adapt to them instead of conforming to the natural decision-making flow of the individuals and teams using them. They also typically have steep learning curves - such that only trained specialists can use them - and a high total cost of ownership.

In the face of the escalating volume and complexity of information and demand for multi-stakeholder transparency and decision support, a health plan needs EDA solutions that not only unlock their data silos and data warehouses, but make EDA self-service for employees, employers, consumers, and providers.

How can EDA help health plans?

The goal of EDA is to improve a health plan’s business acumen by giving leadership access to the data required to make informed decisions – in the right tool and in the right format. Scalable and sustainable solutions are designed to map to the needs of the people who will be using the information, melding with personal, team, and organizational decision-making flows.

EDA solutions can integrate with your existing environment and takes advantage of your existing assets. You can deploy EDA internally to improve operational processes and publish outside of your organization for improved marketability.

INTERNAL IMPROVEMENT

Utilizing the power of EDA across a health plan’s enterprise enables knowledge-driven decisions that improve member health and organizational outcomes through:

  • Quick and easy data visualization

  • Transparent and understandable data

  • Ad/hoc & analysis

  • Actionable information

  • Key Performance Indicators (KPIs)

EXTERNAL IMPROVEMENT

Extending health plan’s EDA to their healthcare providers or vendors improves their partnership through:

  • Transparent information on their comparative performance

  • Review and analysis of their claims history for better performance

  • Viewing and better understanding of their health data for business acumen

  • Collaborating with health plan on strategic business innovations

  • Accessing of real-time information at the point of care so they can make evidence-based care decisions

  • Discovering ways to reduce care costs and improve we

  • Evaluating risks and discharges to improve outcomes

  • Establishing incentives to improve care

Where can a health plan start?

In order to successfully utilized EDA an organization must have EDA resources, technology, data governance, leadership, and enterprise wide partnerships. The steps to ensuring health plan has the aptitude for EDA are as follows:

  • Conduct a EDA Assessment

    • Who are the EDA resources & what is their skillsets?

    • What are the EDA technologies available?

    • Where are the EDA gaps?

    • When are the deadlines for EDA?

    • How is the EDA executed?

    • Address EDA Assessment

    • Identify high ROI EDA Projects

      • Who are the stakeholders?

      • What are the corporate initiatives?

      • Where are the roadblocks?

      • When is the deadline?

      • How will it be completed?

      • Add or enhance EDA Projects as needed

About the Author

Josh Erhardt is a Sr. Consultant and leads the Data Services Community at Pandata Group. He works with clients to employ a framework that provides the data foundation required during the analytics journey. The framework provides a desired level of data management that is sustainable, maintainable, and cost-effective.