3 strategies for success with health data platforms

IDC Research Director Jeff Rivkin shares how healthcare payers are investing in new approaches to data and platforms to get bigger returns from interoperability investments and improve member experiences.

By | 3 minute read | May 7, 2021

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Healthcare is at an inflection point. There are significant regulatory changes – around interoperability and price transparency, for example – which have created more openness and data liquidity across the value chain. With pandemic-induced changes occurring at the same time, we are experiencing an unprecedented rate of transformation.

As I’ve witnessed in other industries, these times are opportunities for new technologies and techniques. For healthcare payers, data and data platforms are at the center of efforts to improve efficiency and member experience, foster provider collaboration, reduce costs and improve overall quality.

I recently talked with Jeff Rivkin, Research Director, Payer IT Strategies, IDC Health Insights about how healthcare payers are thinking about interoperability beyond the mandate. Here are a few key pieces of advice from our discussion:

1. Start with the architecture.

Many healthcare payers are investing in platforms that can handle multiple data sets beyond claims and clinical – such as social determinants of health, remote monitoring, genomics and telehealth.  While the interoperability mandate explicitly addresses data exchange and access through APIs, the real prize is in using this integrated data in ways that improve efficiency, improve member experience and reduce friction with providers.

Jeff advised, “Don’t just build a data lake to meet the mandate. You need a different mindset.” Healthcare payers must find more effective ways to use data available from across the business, and many are turning to platforms to do so.

Open standards, like FHIR, will be important to drive speed of innovation around the development of these platforms. Healthcare organizations can take advantage of the work that is happening in developer communities to deliver standardized, integrated capabilities that form the backbone of these platforms. Organizations can use platforms to support the immediate requirements of the mandates and leverage these investments for broader, high-value use cases in the future.

Read the IBV Research Insight: Insurance on the platform

2. Consent needs to be easier and more transparent.

Many healthcare payers have realized in working to comply with the interoperability mandate they also need to rethink consent management. There is often no system of record for consent on how member and patient data can be shared and used. When patients sign a form on a clipboard, or click a box in the member portal, or accept terms on a mobile app – do they understand what they authorized, for how long and for what purpose? Consent is further complicated by considerations around privacy, delegation, identity management and variation in rules by state and country.

In their journey to better consent management, healthcare payers need to make it easier for patients to give or revoke consent – perhaps by putting it in the workflow during enrollment. They also need to make it clear about what kinds of data can be shared, with whom and for what purpose.

Learn how using blockchain can offer an immutable record of consent

3. Anticipate the future and drive toward sustainability.

One reality faced by healthcare payers is the need to operate at both ends of the spectrum in terms of data management maturity in their platforms. At one end of the spectrum, they are integrating data, such as valuable social determinants of health data in low-tech spreadsheets and faxes, from community health organizations. At the other end, they are managing sophisticated data files from large organizations. As a result, payers need a wide array of different abilities to effectively ingest, transform and enrich data. These include capabilities like clinical natural language processing to make unstructured data more usable. Sustainable approaches are the ones that can effectively incorporate and use these resources.

Jeff also observed that the pandemic tested many organizations’ ability to solve for mandates or COVID-19 response efforts. “If it was a nightmare to spin up an application – on a data lake with an edge server – your approach is not going to be sustainable.”

When I asked Jeff where he thinks the industry will be two years from now, he said, “We have just reached the tip of the iceberg as far as data sharing.” He anticipates continued industry challenges with things like data breaches, data matching and consumer education, but sees that there is an opportunity to move forward with the new data paradigm to the benefit of our collective health.