Health Insurance Companies are Facing a Reckoning on Patient Matching

Stephanie St. Thomas

Stephanie St. Thomas, Director of Marketing

Health Insurance Companies are Facing a Reckoning on Patient Matching

As technology continues to embed itself into our daily lives, we all create more and more data pertinent to our health – through telemedicine, patient portals, medical devices, behavioral health. Even our socioeconomic information is increasingly – and correctly – being treated as health data. With more information available than ever before, shouldn’t payers and providers have all the data they need to work together and improve the quality of health care delivery?

We’re seeing some gains on integrated delivery systems improving quality and value, but not nearly fast enough. As patient-generated data explodes, payers and providers alike struggle to find the signal from the noise and to share information across their fundamentally siloed technology systems.

Related Content: A cloud-based, data-backed MDM solution for member data that is powered by Referential Matching technology

We can’t make progress until we are able to answer a core fundamental question: Are we even talking about the same person?

Payers have often been exempt from this member data matching conversation. With the member ID on every member’s insurance card, payers had a pretty good identifier that worked for a while. But now that payers are becoming more embedded in population health and care delivery, they are facing the same issues of member identification as their provider counterparts.

Data created outside directly billable events becomes difficult to link to the right member record – any maiden name, mis-typed birthdate, or change in address can prevent clinical data from being matched to the member record. But as quality metrics and reporting become increasingly critical to payers’ long-term success, this clinical data becomes more and more valuable, yet frustratingly inaccessible.

Conventional patient or member data matching technologies compare a record from one IT system (say an EHR) with a record in another IT system (say the billing system). But each of these systems will store slightly different demographic data about a person: maybe one has a person’s maiden name, another an old address. These conventional patient matching technologies will therefore struggle to match these records to each other.

Related Content: A cloud-based, data-backed MDM solution for member data that is powered by Referential Matching technology

Verato has pioneered a powerful new matching technology called “Referential Matching.” Rather than directly comparing the demographic data from two patient or member records to see if they match, Verato instead matches that demographic data to its comprehensive and continuously-updated reference database of identities. This proprietary database contains over 300 million identities spanning the entire U.S. population, and each identity contains a complete profile of demographic data spanning a 30-year history. It is essentially a pre-built answer key for all patient/member demographic data.

By matching records to this database instead of to each other, Verato can make matches that conventional matching technologies could never make—even records containing demographic data that is out-of-date, incomplete, incorrect, or different.

Learn more about how the Verato Universal™ MPI – the next-generation in patient matching solutions – can help your business.

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