Well being plans have been preventing in opposition to inaccurate member knowledge, incomplete member profiles and duplicate information for years. With out a watertight method to maintain observe of affected person identities so well being knowledge is reliably linked and accessible throughout a number of companies, payers can’t at all times be assured that the document in entrance of them matches the member they keep in mind.
The pandemic has introduced this into sharp focus: constructive COVID-19 take a look at outcomes aren’t at all times following members from service to service, and because the vaccination program rolls out, figuring out who has had the illness and who has been vaccinated could possibly be troublesome to watch.
As well being knowledge expands exponentially and the necessity to share and join member information turns into extra pressing and complex, the challenges dealing with well being plans will solely develop. Might a novel affected person identifier (UPI) be the reply?
4 member matching challenges that well being plans might clear up with a UPI
1. The healthcare ecosystem lacks 21st Century Cures Act knowledge coordination
The shortage of built-in programs to switch member knowledge securely contributes to questions of safety, cost delays and potential audits and fines. Over a 3rd of denied claims for well being programs end result from inaccurate affected person data, costing them a minimum of $6 billion per 12 months. Whereas this would appear to not impression the payer, the lack to correctly hyperlink claims to members might result in an lack of ability to grasp the chance represented by the members being coated. Or worse, an lack of ability to anticipate and monitor tendencies in members well being and supply proactive healthcare choices.
A singular affected person identifier can join the dots between completely different elements of the healthcare ecosystem so duplicate and incomplete member knowledge could be detected and eradicated. With a extra full image of who a member is, well being plans could make choices based mostly on correct data and alternate knowledge safely and securely. There’s a far decrease threat of performing with out figuring out about current therapy or take a look at outcomes, or speaking utilizing the incorrect handle (and even to the incorrect member).
2. Healthcare suppliers have outgrown conventional matching instruments
With the quantity and variability of well being knowledge to be matched, conventional matching instruments are not match for goal. For instance, an enterprise grasp affected person index (EMPI), which hyperlinks all variations of a affected person’s document throughout a number of services, could appear dependable. Nevertheless, by counting on a single supply of demographic knowledge, EMPIs seemingly replicate errors and outdated data, and will mix information for sufferers who share sure demographic data (for instance, if two sufferers have comparable names and the identical date of beginning).
As an alternative, payers ought to contemplate an identical resolution that mixes member roster data with complete third-party reference knowledge. Member information are matched utilizing referential and probabilistic matching, and related utilizing a UPI. This provides well being plans a extra full image of their members, constructed on dependable well being, credit score, and shopper knowledge sources, and permits all events to grasp the individual on the heart of all of it.
3. Discrepancies in member knowledge make care coordination unattainable
Members could use completely different names or nicknames, their handle could change, and so they could even share a Social Safety Quantity (SSN) with another person. How can well being plans assist to coordinate care in the event that they’re undecided they’re monitoring the appropriate member?
A single digital well being document (EHR) can observe the member all through their healthcare journey with a UPI, so well being plans could be assured that the individual on the cellphone or within the workplace matches the document on display. They’ll monitor and reply to gaps in care, permitting them to raised coordinate take care of higher affected person well being, improved member engagement and money-saving operational efficiencies.
4. Members current to a number of services, inhibiting care plan monitoring
How can well being plans reliably observe remedy adherence, particularly when members current to a number of places? Is there actually a niche in care, or did the member simply attend a unique facility? And if members go to completely different pharmacies, how can a pharmacist be certain the prescription goes to the appropriate individual? All of this may create dangers to affected person security and elevated prices for payers.
A UPI may help. Experian Well being has teamed up with the Nationwide Council for Prescription Drug Packages (NCPDP), which units requirements for pharmacy companies to alternate digital healthcare knowledge. A framework has been constructed for a UPI-based affected person matching resolution that your entire US healthcare community can use. Not solely will this enhance affected person security, it’ll decrease workers time spent on reconciling incorrect information, thus boosting monetary efficiency too.
With regards to mismatched information, prevention is best than treatment. With a Common Identification Supervisor, well being plans can trust within the accuracy and safety of the info they’re utilizing and sharing, promote affected person security, and enhance workers productiveness.
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