Blog

Healthcare Payor Achieves Superior Data Governance in Essential Data Exchange Platform

Jul 15, 2020

The Client

Millions of Americans spread across multiple states trust our client’s organization to offer coverage that best supports their members and their families. More than just providing outstanding coverage, our client strives to educate their members, helping them make decisions and adjustments to their habits to improve their lives for the better.

The Challenge

Our client prioritizes compliance mandates and conducts regular revisions to their procedures, practices, and technology to comply with evolving regulations. A recent mandate aimed to create a greater data governance framework around data extracts leaving the organization.

Our client needed to arrange real-time tracking on all data leaving their organization and control data sharing with current or potential competitors to avoid revealing pricing or proprietary business practices

Through our partnership with the client and our experience implementing similar data governance measures, w3r set out to deliver those results.

The Initial Assessment

Our data governance team began the project with a fundamental assessment of their current state. Implementing an effective data governance framework would require clear documentation of their present processes and systems, interviews with stakeholders and end users, verification of their pain points, and confirmation of their workflow. Additionally, the client would need to identify instances where data contradicted individual requests for restrictions on or exclusion from reporting or data sharing with competitors.

Our audit unveiled three additional and unexpected processes in the data exchange cycle. Each process operated under its own distinct mandate that was wildly different from the others. There were extensive issues with the quality of their data and many systems functioned with a bad or inconsistent understanding of what was being shared.

Moreover, there was a need for a change in their enterprise-wide approach to data governance, encouraging better communication and process ownership from the top down. Existing processes were time-consuming and many bypassed formal procedures to achieve ad hoc results – at the loss of cohesion and accountability.

Our client was unaware of the full extent of the quality and operability issues in their data exchange processes. Our team outlined incremental steps to achieve a higher functioning data exchange with more mature data governance practices.

The Implementation

The first phase of implementation helped our client capture data in their outgoing exchanges with greater accuracy and consistency. Our team did so by identifying critical data for the organization, cleansing that data, and standardizing it before migrating all relevant information from their separate systems into a new data platform.

When designing the user-facing platform, our project team took the pain points identified early in the process and created a clear and streamlined tool for users. The consolidation of over 200 data fields across two competing systems into 125 total fields in a single platform simplified their processes.

Plus, the elimination of text boxes reduced the client’s guesswork, creating a uniform system that encouraged greater consistency from their requests. Regularly sorting through data on national competitors enhanced the ability of our client’s platform to identify data exchange request from the competition, allowing their internal team to remove all proprietary information.

The Results

At the end of phase one, our client had a minimum viable product (MVP) data exchange platform built on exceptional data governance practices. Early users appreciated the overall functionality and ease of use. Their feedback guided the next iteration of the data exchange platform to elevate performance and usability even further.

Though there was a period of adjustment, our work alongside early adopters helped grow their trust in the new capabilities and greater consistency of this platform. Stakeholders in other departments were soon requesting improved data exchange platforms for their divisions. As a result, w3r is currently rolling out this solution enterprise-wide, enhancing their operations and data governance in ways that improve the experience and lives of members nationwide.

 

 

Recent Articles

w3r Consulting Wins NMSDC National Supplier of the Year Award

w3r Consulting, a best-in-class IT consulting and staffing firm, is honored to announce they have won the National Minority Supplier Development Council’s (NMSDC) National Supplier of the Year Award. Receiving acknowledgment from the nonprofit organization signifies...

A Mature AI Strategy Relies on Applying 2 Essential Lessons

It’s crazy to think how quickly artificial intelligence has become a staple of our society, shifting from fascination with ChatGPT in 2022 to widespread adoption less than two years later. McKinsey & Company found that 65% of respondents were regularly using...

Improving HEDIS Measures: How to Optimize Your Member Engagement

It takes considerable effort for healthcare payers to distinguish themselves from the noise. Employers and consumers have a smorgasbord of healthcare plan options available to them. Without clear standardized metrics to compare the level of quality care, healthcare...

How to Recover from Nurse Burnout: 4 Tips to Help You Recharge

When we talk to nurses these days, there’s a bit more optimism than there was a few years back. They’re increasingly happier and more satisfied with their work, which is reassuring after the worst days of the pandemic. That said, there is still a fairly high number of...

How to Work with a Recruiter to Find and Secure Better Jobs

When you’re searching for a new job, it’s easy to feel very isolated. You apply for dozens of open positions, conduct a smattering of interviews, and mostly hear crickets. If you’re searching for about 21.2 weeks (the length of unemployment according to the BLS in May...

How to Improve Your Technical Resume & Stand Out From the Competition

How do you stand out when you’re competing with hundreds of other people for a single job? That’s the reality for IT professionals ever since job boards and social media platforms have simplified the application process. Yes, most applicants will be woefully...

Which Is Better for Your Career: Choosing Hybrid or Remote Work?

The pandemic proved that a little job flexibility is more than manageable. When organizations trust high-quality workers to do their jobs, they’ll get the work done. Better yet, remote appears to foster a greater sense of productivity, balance, and loyalty in...

w3r Consulting Wins Best and Brightest Metro Detroit

w3r Consulting, a best-in-class IT consulting and staffing firm, is thrilled to announce its recognition as one of Detroit's Best and Brightest Companies to Work For® in 2024. This is the fifteenth consecutive year w3r has won this prestigious award, which...

Share via
Copy link