Payers are data obese with information that goes unused

Health systems and insurers do not lack for data. There's enough to fill "data lakes" of information that is stored, but not always looked at, analyzed or used.

What systems lack is a way to collate individual patient data and to make sure it is complete, according to a panel of experts speaking at America's Health Insurance Plans conference in San Diego last week. 

What's happening is that data is piling up somewhere like household items thrown into an "everything" closet that people promise to clean out "someday."

"We treat our data like something we'll look at when we have time," said Mohan Nair, senior vice president and chief innovation officer for Cambia Health Solutions. "That's the data lake. We are data obese. We literally don't know what to do with that data."

Because the data is not used, and more importantly, not linked, Amazon and Netflix know more about the consumer than healthcare systems, Nair said. 

"We can learn more data from a consumer's credit card statement," said Rahul Dubey, former senior vice president of Innovation and Solutions for AHIP.

The solution is for data to be refined and linked, according to Josh Schoeller, senior vice president of Healthcare for LexisNexis Risk Solutions. 

Technology plays a part in linking and organizing the information by looking for language associations. 

But Nair recommends also looking for nuggets of information found in the non-collated data. 

There must also be an equitable sharing of data between payers and providers so that insurers get a full picture of the patient.

There's a debate as to whether the gap between data and outcomes is a cultural issue in health plans or a technical issue. It's both, Nair said.

Also, to meet value-based initiatives, the data can't be viewed as a collection of illnesses or claims, he said.

"When you go claims up and start treating the world like illness, you'll find illness," Nair said. "But that's not treating health."

Nair also recommends that payers rethink their policies on prior authorization.

"If we want to learn about the consumer to control them, the relationship erodes," he said. "If you want to build a long-term relationship with consumers, you have to provide a better way for prior authorization."

The data from electronic health records is seen as clinical data, but it's really claims data because it's a record of how you get paid, Nair said. 

Another issue is duplicate records on individuals in the database. In signing people in, often a new patient record is started in an effort to save time.

It's estimated that the average hospital has 12-16 percent duplicate records in their databases, said Shawn Frazier, vice president of Healthcare Sales at VisionWare in Massachusetts.

"If you don't have the information correctly, it's difficult to build analytics," he said.

It's also costly. Frazier estimates that medium-to-large-sized insurers waste up to $2 million a year in sending out duplicate mailings.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com