Do data collection and processing inefficiencies slow you down and produce flawed insights?

You need to be able to integrate and analyze vast volumes of data from various sources – like hospitals, clinics, and pharmacies – to:

• create a unified member 360° view
• feed data to health information and clinical data exchanges
• support internal analytics initiatives

But that’s very difficult when your data is siloed between claims, membership, provider, financial, and other systems. It may also need to be standardized from formats like X12, HL7, FHIR, and other proprietary files and systems. And, in some cases, data may reside in on-premises systems that are difficult to access, such as mainframe or IBM i systems with complex data structures.

The Precisely Data Integrity Suite offers real-time data integration that brings even the most complex data from multiple systems into a consolidated environment, ensuring that your data is seamlessly integrated, comprehensive, and up-to-date for timely analysis.

The Suite catalogs data as it’s integrated to simplify discovery and automate profiling and analysis – so you can achieve significant performance improvements, reduce data processing times, and efficiently deliver high-value data and analytics.

Precisely also offers data quality capabilities that further enhance your data by ensuring it is standardized and validated, which is crucial for maintaining the accuracy and security of health information. By implementing robust data quality measures, healthcare organizations can ensure that only validated data is exchanged.

Watch the webinar: How to Ensure Your New Hybrid, Multi-Cloud Environment Isn’t Recreating Old Problems

Healthcare leaders are constantly navigating the complexities of claims processing, membership management, and financial administration – all areas where data accuracy and operational efficiency are crucial.

Do any of these situations sound familiar?

• A claim is lost or an amount gets transformed incorrectly as it moves between systems.
• Membership information does not match that of your vendors, Centers for Medicare & Medicaid Services (CMS), and state Medicaid systems.
• It is a struggle to quickly know if a subsidy payment for a member equals the expected amount.
• Inaccuracies in financial data take time to resolve and impact the general ledger.

With Precisely’s enterprise data reconciliation solution, you can:

• Ensure data accuracy as it moves between your internal systems.
• Reconcile data from vendors and partners before it impacts your business.
• Prevent data issues by validating data prior to reconciliation.
• Gain consistency and efficiency so your teams can focus on high-priority tasks.

Hear real-world customer success stories: Automating Data Reconciliation for Insurance with Data Integrity

Are your provider directories accurate, up-to-date, and compliant with and state regulations?

Delivering reliable information to your members with enhanced data integrity and operational efficiency is possible. Advanced data reconciliation from Precisely automates the process of identifying and correcting discrepancies across multiple data sets – ensuring your directories are accurate and complete, boosting member satisfaction, and supporting regulatory compliance.

If you need to improve the management of your provider data, master data management (MDM) from Precisely offers significant benefits. An enterprise-grade MDM solution creates a single, reliable source, or “golden record” for your strategic data assets, ensuring:

• Timely, consistent, and accurate decision-making across your organization.
• Enhanced data integrity, leading to better network adequacy and regulatory compliance.

Accurate provider location data is another essential component to ensuring your provider network meets your members’ needs. Precisely’s advanced geo addressing solutions help healthcare organizations optimize provider networks and value-based contracts by supporting critical analysis into many areas, including:

• Resource allocation
• Patient accessibility
• Personalized patient care

Accurate location data is also essential when opening new facilities like hospitals or dental clinics, giving you insights into:

• Nearby healthcare providers
• Population density
• Pricing
• Zoning and land use restrictions
• Demographics
• Potential service gaps

Location data can also support route optimization tools that simplify planning and effective deployment of personalized at-home care or home health services. Hyper-accurate geocoding ensures providers are at the right locations for the right duration of services – improving  service delivery and patient experience.

Pharmaceutical companies can leverage personalized interactive video (PIV) to increase doctor engagement. PIVs introduce pharmaceutical products to doctors before a sales rep visit, providing a personalized and interactive experience. This enables sales representatives to tailor their presentations to the doctor’s interests and needs, resulting in more effective meetings.

Use PIVs to ensure that your team’s interactions with doctors are more relevant and engaging, ultimately driving better outcomes and strengthening relationships.

By leveraging Precisely’s personalized, interactive solutions, healthcare organizations can enhance operational efficiency, ensure accurate provider information, and deliver superior care to their members.

Learn about how Rexall uses geospatial data analytics to align offerings with demand

Understanding social determinants of health (SDOH) is crucial for delivering effective and equitable care.

Data enrichment and geo addressing solutions from Precisely empower you to analyze data by zip code, communities, neighborhoods, and school zones. Combining this with demographic, street, and climate risk data gives you a comprehensive understanding of the factors impacting the health of individuals and communities.

This holistic view enables you to effectively:

• Identify and address specific needs.
• Develop better community health initiatives.
• Allocate resources.

Ultimately, you are enabled to make informed decisions that support your mission to provide high-quality, equitable care for all your members.

Precisely can also help empower your members to choose the right healthcare plan for them with personalized interactive videos (PIVs). PIVs allow your members to navigate information at their own pace and improve their understanding of plan options, leading to increased enrollment and retention.

To streamline your enrollment process, our data reconciliation solution delivers the accuracy and efficiency you need. By reconciling your membership and premium data across various internal and external sources, your records stay up-to-date and aligned with CMS, state, and other third-party data. Our automated solutions enable you to identify and correct duplicates, discrepancies, and other data issues, providing you with a single, reliable source of truth.

This improves your visibility into membership analytics, enhances operational efficiency, and ensures compliance with regulatory requirements, ultimately supporting better decision-making and giving you a competitive edge.

Read how a State-based Health Plan Improves Membership Visibility, Insights and Data Quality

Regulatory compliance and reporting requirements continue to shift, and healthcare organizations need to maintain consistent adherence through it all.

Precisely offers comprehensive software, data, and strategic services that can help your organization comply with a variety of regulations.

Our Data Integrity solutions can help you establish a robust framework to proactively find, understand, and manage data – ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA), CMS, state regulations, and internal audit requirements. This includes maintaining data quality, integrating data sources, and managing metadata effectively to ensure data privacy and security. Here are some examples:

• Medicare Star Ratings and Medicare/Medicaid Dual Eligible Members

Our data quality solutions ensure that your data is accurate, complete, and reconciled, which is essential for meeting reporting requirements for Medicare Star Ratings and dual-eligible members. Automated validation and cleansing processes enhance operational efficiency and support regulatory compliance, which can improve your Healthcare Effectiveness Data and Information Set (HEDIS) scores while increasing member satisfaction.

• Prompt Pay and Financial Regulations

To comply with financial regulations like Sarbanes-Oxley (SOX) and National Association of Insurance Commissioners (NAIC) Model Audit Rule (MAR), use our data reconciliation solutions to automate data set comparisons and reveal and correct discrepancies. This ensures your records are accurate and complete, reducing risks and streamlining audits.

• Global Privacy Regulations

Ensure compliance with regulations like the General Data Protection Regulation (GDPR), the California Consumer Privacy Act (CCPA), and others around the world. Our data governance and data catalog solutions help you identify and classify personally identifiable information (PII) while reducing costs and improving compliance.

• AI Legislation

Prevent skewed outputs and inaccurate recommendations from your Artificial Intelligence (AI) initiatives, and stay compliant with legislation like the EU AI Act. Precisely’s data governance framework ensures that data used in your AI models is accurate and relevant for high-quality results.

Read How a Leading Insurer Leveraged Data Quality to Ensure Regulatory Compliance

Efficient healthcare operations and better patient outcomes depend on timely access to data.

Data availability delays can negatively impact your care coordination and customer service, so you need more efficient solutions to improve accessibility.

With Precisely’s data integration capabilities, you can access and analyze data in real-time, taking your operational efficiency to the next level. That means accessing the freshest data possible for analysis – no waiting on lengthy administrative processes to get the information needed for decision making.

The result is a drastic improvement in runtime, which enhances the speed of analytics and the timeliness of insights. With more relevant information, you’re able to drive better performance, productivity, and profitability.

The role of data governance, data catalog, and data quality

Before making data accessible to its users, it’s critical to consider the governance of that data and the quality of the data in flight.

Data governance processes enable your organization to consider who is responsible for and who should have access to data.

With our data governance and data catalog solutions, you can easily discover and understand your data:

Our data governance solution provides you with a framework for managing data assets throughout their lifecycle, ensuring data is understood, reliable, and secure.

By establishing clear policies, roles, and responsibilities, data governance helps you maintain control over your data. This structured approach is crucial for real-time data access because it ensures that data is consistently managed and trusted across your organization.

Our foundational data catalog acts as a centralized repository that provides a comprehensive view of your organization’s data assets. It helps users quickly discover and utilize data by providing metadata and data lineage.

Data quality tools are also essential to ensure that the data accessed in real time is accurate, complete, and consistent. These tools automate the identification and correction of data issues, ensuring high-quality data across all systems.

There are additional considerations when managing data in motion, including streaming data. If business rules aren’t applied to validate the data, previously accurate data can become inaccurate as it’s moved and transformed.

Rules can be applied to data as it streams, in addition to applying rules to the data in the systems where it resides. Data observability capabilities are critical to ensuring you can proactively uncover data anomalies in real-time data and take action before they become costly downstream issues.

When combined, data integration, data governance, data catalog, and data quality capabilities create a robust ecosystem that supports real-time data access. By leveraging this set of services in the Precisely Data Integrity Suite, your healthcare organization can unlock the full potential of your data, enabling real-time access and ensuring your data is ready for AI and advanced analytics to provide the best possible care and customer service to your members.

Learn more about Embracing a Streaming-First Approach to Digital Modernization