Featured in First Report Managed Care
By Clay Ritchey
The ever evolving and pervasive digital ecosystem has transformed the way consumers research, engage, and transact—with more transparency and efficiency than ever before. And as health care digital transformation continues, consumers are expecting the same experiences when they consume health care as well. To support this need, new interoperability regulations, such as the 21st Century Cures Act, are empowering individuals to access and share their health care data more easily than ever before, presenting provider organizations with an opportunity to dramatically improve the patient experience. But this isn’t just about consumer satisfaction, or compliance with regulations, this is also about the health care ecosystem recognizing that their traditional captive patient acquisition strategies are at risk of being disintermediated at a rapid pace. More people are using “Doctor Google” and telehealth experiences rather than leveraging a primary care physician to navigate their patient journey, along with the emergence of unaffiliated urgent care providers displacing the emergency room are just the tip-of-the-iceberg challenges creating a clear mandate for enhanced digital engagement strategies across the care continuum.
Why Identity Data Management Matters
As the health care industry continues to embrace the interoperability requirements established under these new rules and consumer preferences, it’s becoming increasingly important that health care organizations can provide complete, clean, trusted data that’s ready to share both with consumers and other health care organizations. Knowing who is who, ie, being able to unambiguously connect, identify, enrich, manage, and activate data for one person that lives in siloed sources, is foundational to the ability to share access to health data confidently and appropriately. It is also critical to the success of health systems, as it underpins all consumer initiatives meant to create a better health care experience.
In fact, the vast majority (98%) of health care executives surveyed for a recent study expect an increase in data requests from other organizations in the coming years. Additionally, the study—conducted to provide new insights into health care executives’ data management strategies—found that 97% of those surveyed predict an increase in data coming into their organization from external sources.
To ensure a more seamless consumer experience, health care organizations are investing in more robust digital access, including digital front doors and portal apps, eg, a centralized point of access for patients across multiple platforms. Not surprisingly, this exacerbates both the challenge and urgency of achieving a complete and trusted longitudinal view of the patient journey.
A 2023 survey conducted by the Healthcare Financial Management Association to understand the digital and IT investment priorities of health care executives in 2024 found that 85% expected their organization’s digital and technology budget to increase this year, and that digital front door or virtual care were among the top three priorities for investment.
A successful digital front door hinges on being able to correctly identify patients and members, and the consequences can run deep if identity data management isn’t properly developed. Identity data management ensures every individual has a single, accurate, and comprehensive health record, and that all the attributes (preferences, contact information, social determinant of health [SDOH] factors, etc) of the person are well understood, thereby facilitating better analytics, informed decision-making, and improved care and experiences. Failure to successfully ingest, match, retrieve, and use identity data from a diverse set of sources threatens to negatively impact overall care productivity, outcomes, patient retention, and the organization’s ability to survive and thrive, according to a report based on the data management strategy survey.
As health care organizations continue to centralize and migrate data to the cloud while re-imagining their clinical data analytics and digital engagement capabilities, knowing the identity of a patient through modern identity data management strategies has become a critical must-have foundational endeavor.
Incorrect identity data can also wreak havoc on health care stakeholders’ bottom line. For instance, 35% of all denied claims result from inaccurate patient identification, costing the average hospital $2.5 million and the US health care system over $6.7 billion annually, according to a 2021 Black Book survey.
Furthermore, duplicate records are proving to be an expensive and prevalent challenge. Research has shown that on average, 24% of an organization’s health records are duplicates, and that duplicate patient electronic health records (EHRs) cost hospitals on average $1950 per patient, per inpatient stay.
Despite the importance of identity data management, two-thirds of health care organizations are not completely confident in their data management infrastructure to protect the integrity of this data, and nearly half report that their data is still stored in fragmented, siloed systems. The data management strategy survey also found that almost half of the responding health care organizations believe inaccurate and unmatched patient and member data negatively impacts care.
A 360-Degree View
The health care industry must tackle these challenges if we are to advance better outcomes and value for all. Making the right investments in robust identity solutions, such as a health care master data management (hMDM) system, holds strong potential to drive numerous returns for payers, providers, life sciences, public health, and beyond.
Not all solutions are created equal, so when supporting high-stakes use cases in health care—it is vital that organizations leverage an hMDM solution that is built natively in the cloud with accuracy and identity data management at its core.
Organizations should look for identity data management solutions that also incorporate referential matching, a more sophisticated method that matches demographic data from each record to a comprehensive, continuously updated, and highly curated reference database of identities from 30 years of US population data. Referential matching results in dramatically higher matching rates than older technologies that rely on deterministic and probabilistic algorithms. This technology also allows health care organizations to layer patient clinical data from EHRs with consumer data from customer relationship management systems and other third-party demographic information to identify exactly where a person is within their health care journey. Ultimately, this enables a complete and trusted 360-degree view of the patients, members, providers, and communities that health care organizations serve.
Digital transformation in health care is no longer a distant goal, and organizations across the health care continuum must be prepared for an imminent influx of information as health organizations generate more data than ever before. Having complete and accurate member and patient data is going to be critical to supporting the health care industry in its quest to improve outcomes, reduce costs, and ensure compliance.