Health IT’s Need for Data Integration

Health IT’s Need for Data Integration

The challenge of data integration is wreaking havoc within Health IT systems.  It’s costing health and human services agencies billions of dollars, and their customers a reduction in quality care.  We’ve discussed the importance of data integration here before, but it continues to be an issue that is costing us dearly each year.

More revealing was a survey of 155 IT executives and program managers who work with health care and other social service benefits.  The MeriTalk survey found 63 percent of caseworkers stated that enrollment rates for health care assistance and/or benefits have increased at their agency in the last two years.  However, 85 percent of managers say their agency faces challenges when it comes to the eligibility and verification of health care beneficiaries.

The issue?  On average, it takes 16 days for an agency to confirm health care benefit eligibility for a new recipient.  Moreover, it takes 2 weeks to verify the status of a current recipient if it comes into question.  Despite the fact that the services are an immediate need, it’s going to take a few weeks to validate that payment for the services can actually be made.

Caseworkers estimate that 89 percent of their agency’s current beneficiaries list is correct.  This means approximately 11 percent of the people who receive government health care benefits are not actually eligible.  This translates into huge waste, and carries a cost of correcting the issues retroactively.

This is not to say we need to deny healthcare to anyone, only that they take the proper path to obtain it.  They need to be on the proper program, and, in many instances, could not be getting the care they need, on top of the inefficiencies and waste.  In many instances, the issue begins with misinformation by the patient, but it’s the healthcare providers’ inability to verify coverage that is core to the issues.  Data integration could solve these problems.

The lack of data integration carries with it a penalty of waste.  This is the case if you’re a health care provider, or a company that manufactures tires.  The ROI for data integration is typically 20 times the cost of technology and deployment, and that typically occurs within the first year.

Despite the compelling business case, industries are reluctant to begin data integration projects, mostly due to the complexity and perceived costs.  Also, in many instances, there are turf issues from department to department.  Those issues are much harder to solve.

Moving forward, there is a core strategic need to deal with data integration within health IT, as well as within other industries.  These days, data integration patterns are well understood, as well as the solutions and the benefits.  Resistance seems to come from a lack of understanding, more than from real pushback.

Data integration use cases seem to make my radar each week, which is much more often than 5 years ago.  To me, data integration seems like a no-brainer, all things considered.  We have some problems to solve, so we may want to get busy.