The driving philosophy behind healthcare (as reflected in the Hippocratic Oath), “do no harm,” affects every aspect of the industry—including data usage. The amount of healthcare data in the world has grown exponentially in recent years, as has its application. To carefully (and efficiently) harness the power of their growing databases, health teams must use data management tools.

Healthcare data management tools are solutions that help health teams collect, organize, and utilize their data. By implementing these tools, payers and providers can improve operational efficiency, cost control, and patient outcomes.

This article explores data management solutions that health systems need to revolutionize their workflows.

1. Data Storage, Integration, and Analytics

The foundation of every data management strategy is a central repository that hosts an organization’s data, allowing users to sift through vast amounts of information and extract valuable insights. Healthcare analytics software delivers this capability for health organizations, enabling providers and payers to store, share, and analyze critical data.

Data sources that healthcare analytics software draws from may include:

• Electronic health records (EHRs)
• Claims data
• Social determinants of health (SDoH) data
• Historical health data
• Pharmacy records
• Admission, discharge, and transfer (ADT) systems

Benefits for Payers

Analytics software improves claims processing and reimbursements by centralizing patient and claims data for more efficient tracking. This allows payers to automate and expedite much of the claims process, from patients’ mobile payments to approval and reimbursement. Additionally, automated workflows minimize the risk of errors and reduce administrative overhead.

Benefits for Providers

For providers, analytics software enables data-driven decision-making, thereby promoting patient-centered care. Integrating data from multiple sources gives a holistic view of patient health, which providers can use to make informed decisions and implement necessary interventions.

2. Predictive Analytics

In addition to deriving insights from relevant health data, providers and payers can leverage data algorithms to predict what is most likely to happen in the future. Arcadia’s article on predictive analytics describes the process as “the evaluation of current and historical data through statistical modeling, data mining, artificial intelligence (AI), and machine learning techniques to predict future events.” 

To facilitate this process, providers need a sophisticated data architecture that stores and analyzes essential information. The right analytics platform will not only extract insights from real-time data but also predict future health events, impacting patient outcomes and resource management. 

Benefits for Payers

Understanding potential health risks supports accurate patient stratification to ensure reimbursements align with a patient population’s risk levels and expected outcomes. This is especially important to sustain value-based care (VBC) payment models, as it ensures adequate provider compensation for high-risk patients. 

Benefits For Providers

Predictive analytics enables providers to identify health risks early and intervene before they escalate. These high-level insights allow for personalized care plans and patient outreach, which help providers allocate resources efficiently and engage their patients. 

For example, organizations can develop healthcare content based on trends across a patient population to generate interest in proactive care, like screenings or vaccinations. Plus, predictive analytics yields significant cost savings for patients by reducing unnecessary expenses associated with costly treatment needs like hospital stays or readmissions.

3. Healthcare Dashboards

Healthcare dashboards consolidate and visualize data points from various sources to present health data in an easily digestible format. While examples of dashboard models abound, here are a few key metrics that are most valuable to providers and payers:

• Patient satisfaction, which may be impacted by treatment outcomes, wait times, and other factors
• Average length of stay (ALOS), which measures the average number of days a patient spends admitted to a health facility
• Contract summary data, which includes medical costs and utilization trends
• Cost per treatment, which measures the cost of a specific procedure or intervention

Benefits for Entire Healthcare Organizations

Because healthcare dashboards can be optimized to track various metrics, all teams across the care continuum can benefit from this tool. Dashboards enable health organizations to transform data points into actionable insights, improving enterprise-wide performance. For example, patient satisfaction dashboards can reveal gaps in care, and contract summary data can surface member enrollment trends.

4. Revenue Cycle Management (RCM) Software

Revenue Cycle Management (RCM) solutions manage financial processes like coding and billing, copay collection, claims submission, and reimbursements. These tools simplify and automate workflows to improve efficiency while ensuring compliance and data security.

RCM software’s key features include:

• Automated coding and billing, which speeds up claims submission and ensures the right codes are assigned to each payment
• Claims management, which allows health organizations to track the status of a claim and manage follow-up actions as needed
• Payment collection, which involves activities like sending invoices, processing insurance payments, and collecting payments from patients

Benefits for Payers

RCM solutions automatically flag errors before processing claims, ensuring they’re compliant with payer requirements. By applying automation to claims submission and processing, RCM tools ensure efficient claims management and reduce the risk of denials or underpaid claims.

Benefits for Providers

As mentioned above, dedicated RCM tools enable providers to submit claims more efficiently. Since these tools streamline claims submission and processing, providers ultimately realize faster reimbursements and more accurate compensation when using these tools.

Ultimately, the health system exists to serve the larger patient population. The most important benefit of data management tools is the improved quality of care that patients will experience as a result. 

To deliver the best care at an equitable cost, health systems must implement tools and best practices that optimize processes like data analytics and RCM. With the right resources, health teams can work together to unlock benefits for all parties across the care continuum.