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Data Cleansing & Curation A Look at Verinovum’s Approach to Data Cleansing & Curation FOR PAYERS A Look at Verinovum’s Approach to Gartner has named Verinovum in Data Cleansing & Curation reports for payers … “We’re honored that Verinovum has been recognized by For payers, Verinovum provides the ability to streamline Gartner in multiple reports over the past several years. clinical data acquisition, perform data cleansing and curation Verinovum is a leader in addressing one of the most vexing and flexibly integrate the resulting clean data into enterprise issues in the industry; unclean data. We believe these Gartner decision systems. This provides transparency into the quality recognitions validate our unique and singular focus on data of the data asset available as well as services to improve cleansing and curation to make data usable for practical quality and align to various business cases. use cases such as chronic disease management, population health, and analytics to help drive shared savings,” says Mark Gartner Clients can access the below reports in which McCurry, CEO of Verinovum. Verinovum is named, including: PAYERS 1. U.S. Healthcare Payer CIOs Should Avoid Data Lake Mistakes With Clinical Data Integration, Mandi Bishop – May 3, 2018 (refreshed October 16, 2019) “Payer CIOs want to know whether data lakes can deliver quick wins for business leaders hungry to derive actionable insights from unstructured and nonstandard clinical data. To avoid drowning in data, CIOs must first specify goals and critically compare internal capabilities to vendor solutions.” 2. Healthcare Payer CIOs, Leverage Vendor Partners to Succeed at Clinical Data Integration, Mandi Bishop – August, 2018 (refreshed February 3, 2020) “Healthcare payer IT teams typically lack the specific expertise needed to execute complete clinical data integration initiatives, leading to suboptimal business outcomes. CIOs must assess vendors against the entire CDI value chain to pick partners and improve delivery.” 3. 5 Actions U.S. Healthcare Payer CIOs Must Take When Purchasing Risk Adjustment Management Systems, Bryan Cole and Mandi Bishop – January, 2019 “Profitability in government health programs depends on complete and accurate coding of members’ health status. U.S. healthcare payer CIOs must prioritize analytics and verify AI capabilities when seeking new or replacing risk adjustment optimization vendors.” 4. The Current State of Clinical Data Integration Among U.S. Healthcare Payers, Mandi Bishop – May, 2019 “U.S. healthcare payer CIOs face increasing market and regulatory pressures to implement clinical data integration as a critical capability — yet ROI remains elusive. To deliver business value at scale, CIOs must accelerate plans to adopt a comprehensive enterprisewide solution.” 5. Hype Cycle for U.S. Healthcare Payers, 2019, Bryan Cole, Jeff Cribs and Mandi Bishop – July, 2019 “This Hype Cycle provides critical input for strategic planning by tracking the maturity levels and adoption rates of emerging payer technologies and approaches. U.S. healthcare payer CIOs should use this research to plan their investments to optimize and transform.” Verinovum Insight: and manual error remediation. When organizations saw that this error remediation process itself could lead to more Payers have been adept for many years at extracting insights errors and inadvertently leave some data behind, many payers and driving their business outcomes with claims data. And swung too far to the other side of the spectrum, from rigid that claims data has presented a unique way for them to have data capture and storage to data warehouses and data lakes. better intel about the financial drivers behind their business. This approach offered more flexibility to be sure, but the reality is that data lakes create the illusion of a useful asset However, one of the great pain points has been the timeliness but lack data quality, precision, structure, and context. And and completeness of claims records. Payers are now coming it’s difficult to get the right data back out of the data lake for to recognize that the availability of clinical data in their the right use case when the time comes. analysis – both for federal reporting and quality measures as well as their internal risk assessment and associated In contrast to these approaches, Verinovum works to administrative decision making – would be greatly bolstered emphasize and focus on the use cases and the data that are by that clinical data. most pressing for payers and their business goals and align our data curation tactics to meet those ever-changing needs. Verinovum helps overcome this challenge with a unique We believe this helps maximize value for payers now, while approach to making clinical data actionable for payers. also presenting a flexible pathway to accommodate changing needs in the future. We take on the burden of receiving Originally, most payers aimed for simple clinical data and cleaning the data, aligning it to current business values, integration, which is a highly structured approach, but one and delivering it back to payers in a file format, type, and that requires ongoing resources, incremental improvement, frequency that meets their needs. “Providers and health plans are increasingly demanding integrated claims and clinical data to drive and support value-based care programs. These organizations know that clinical and claims information from more than a single organization is the only way to get a true picture of patient care. From avoiding medication errors to enabling an evidence-based approach to treatment or identifying at-risk patients, the value of integrated claims and clinical data is immense — and will have far-reaching influence on both health outcomes and costs of care over time.” - Claudia Williams, CEO of Manifest MedEx, a California nonprofit health data network Verinovum’s solutions help payers to: Feed business decision systems with clean, clinical data Reduce administrative cost and time to acquire clinical data Make clinical data available for value-based activities Educate technical and business stakeholders about the nuances of clinical data Engage in clinical data profiling to inform provider relations and contracting BOTH PAYERS AND PROVIDERS 1. U.S. Healthcare Administration’s Future Requires a Real-Time Payment Ecosystem Powering Value-Based Care, Bryan Cole, Barb Mann, Mandi Bishop – November, 2018 “Claims denials, rework and lagging payments sap efficiency from the U.S. healthcare system — draining profits from payers and providers alike. CIOs must use this model to guide development of real-time payment processes in support of value- based care to improve consumers’ health outcomes.” 2. Healthcar’s Digital Data Dexterity Demands a Data Curation and Enrichment Hub, Laura Craft – June, 2019 “Healthcare CIOs who do not deliver expert data capabilities will imperil their organizations’ digital transformation. CIOs should use this research to get informed about critical new competencies for data curation, management and enrichment.” Verinovum Insight: In addition to data curation for payers and providers individually, Verinovum also takes on the role of arbiter between payer and provider, bridging the communication gap between the two. We recognize that neither entity can see the full picture from where they sit in a way that will allow them to make informed decisions. Our goal is to raise the quality and visibility of the clinical asset for both parties, so that when decisions are made about value-based contracts between the two parties, those decisions are based on the most timely and accurate information possible. One example of the communication gap working against payers and providers is when a payer receives claims data (without adequate clinical information) and makes assertions about the services rendered and care delivered based on that information. The payer may decide to not remit an incentive, and the provider will then need to undertake an arduous complaint or appeal process. If, however, the payer could have more clinical information on hand – more closely aligned to what the provider organization sees in the EHR – the payer could make more informed decisions, and the disconnect between payer and provider would be significantly less detrimental to both parties – and to patients. To learn more about the #VerinovumDifference and how we can help you do more with your data in 2020, CONTACT US today. Three approaches to making data actionable: 1. The “Highly Structured” Approach: PROS Repeatable approach; solid foundation Strict data standard guidelines = increased data quality confidence, precision CONS Requires ongoing resources, incremental improvement, manual error remediation Error-prone data remediation mapping; mistakes leave data on cutting room floor 2. The “Ad Hoc/Data Lake” Approach: Source 1 Source 2 Source 3 PROS Quickly land data into a central data store Potentially cost effective CONS Creates illusion of a useful asset but lacks data quality, precision, structure, context Heavy resource draw – continuous data quality review, data Data Lake science analysis, cleansing 3. Verinovum’s “Data Curation” Approach: Source 1 Source 2 Source 3 Source N PROS Transparency into data quality early and often Transparent Data Quality Check Reliable, traceable data that’s reusable for the next use case CONS Current Use Case Drivers Repository Queue New territory – needs additional internal education Collaborative ‘partnership’ and resource investment Gartner Disclaimer Gartner does not endorse any
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