Blog

Healthcare Payor Upgrades Member Experience with Automated Data Pipeline

Apr 6, 2020

The Client

When millions of Americans think about health insurance, our client is one of the first payors on their mind. The organization has a reputation for high-quality and affordable coverage, accepted by an extensive array of general health and wellness providers and specialists nationwide. Their commitment to the ongoing improvement and expansion of their products and services offers their members personalized coverage that continues to evolve, improving their members’ experience, and increasing overall health and peace of mind.

The Challenge

The client had plans to enhance their members’ experience, but lacked the necessary understanding and cohesion across their data to pinpoint their greatest areas of opportunity. In its current state, data was decentralized, spread across multiple sources without any uniformity or verified accuracy. This prevented the flow of critical data into internal analytics and limited groundbreaking collaborations with external partners.

Consider, for example, the client’s planned partnership with an online pharmacy. Together, the two organizations would supply the client’s members with prescriptions straight to their homes. But first, they needed to integrate relevant data sets between the two organizations. The barrier created by their segregated data threatened to reduce the speed and accuracy of their proposed full-service prescription program.

Rather than allow this or other data-driven initiatives to flounder, the client engaged w3r for help. Their challenges required the expertise of a data integration and engineering partner familiar with HIPAA compliance, the healthcare industry, and their organizational best practices. For that reason, they chose w3r Consulting.

The Solution

Before the start of our data integration, our team set out to define the requirements. We began by conducting a needs assessment with various stakeholders across both organizations to define the scope, business requirements, and technical requirements. We then identified all of the relevant data sources, established data management practices, defined how much time it would take to process the data sets, and agreed to a project timeline. As a result, accurate expectations and standards were locked in long before the final deliverable.

Using this information, the w3r project team proceeded to create a data pipeline solution.

  • We extracted the data from the source systems to compare alongside client data sets.
  • We evaluated external and internal data, transforming it from the source schema in instances when it failed to comply with the client’s established standards.
  • We loaded the cleansed and standardized data into a HIPAA compliant yet accessible data warehouse, mapping the data to match fields with the client’s member data.

After loading relevant data sets from internal and external sources, our team created an automated framework to implement a seamless pipeline. The established production system gathers data under the guidelines of a specific business logic and automatically converts the source data into our client’s specified format.

Results

With their automated pipeline in place, our client is able to process, load, and transform data in ways that are secure and compatible with target destinations. On an organizational level, this will allow them to better navigate the complex data exchange between other healthcare organizations, government agencies, and authorized vendors.

More immediately, they’ve been able to efficiently verify and process prescription requests from their pharmaceutical partner. On a daily basis, the automated production system reviews requests, confirming that inquiries for the pharmaceutical home-delivery service are from current members who qualify for the requested prescription. Our work operates in the background without any maintenance, allowing our clients to focus on bringing their members the best experience possible.

Can data pipeline solutions enhance your member experience, operational capabilities, and more? Reach out to our team to discuss how you can unlock the full potential of your data.

[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

Recent Articles

Ready to Find a New Job in 2025? Your Worn-Out Strategies Won’t Cut It

You’ve set your job alerts. You’ve updated your LinkedIn profile. If you haven’t searched for a new job in a while, it might feel these actions are enough to find new opportunities. Unfortunately, that’s not true in the current market. According to The Wall Street...

How Low-Code No-Code Platforms Can Transform Complex Industries

The ability to access and leverage structured and unstructured data has empowered organizations to understand challenges, predict outcomes, and prepare for a better future. However, unlocking the insights hidden in that data requires alignment between the analytical...

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...

Share via
Copy link