Each time an insurer adds a new member to its ever-expanding list, it not just means more business. The payer instantly gets a new task at hand: collecting the medical history of the patient. It’s easier said than done as payers don’t get just a handful of new members. The number easily touches four digits daily, which makes data gathering and compilation a Herculean task. Payers have to overcome multiple obstacles to obtain the correct information from the doctor’s office, which is no less than a mad rush as they go about the task physically, digitally, and through outsourcing.
- Collecting the required information offline remains the most common practice. But ‘common’ doesn’t make it easier by any means. Companies press into service a battery of staff for the job. They start contacting doctors, clinics and hospitals from the word go, seeking information about each member. Rarely do they get the detail instantly. Their wait for the information can drag on for weeks, whether it’s coming physically or digitally. Often they have to visit the doctor to collect the details. This becomes more challenging during the January-April period. Since a bulk of the process is manual, duplication and fatigue come as no surprise.
- The reason the process largely remains manual is not accuracy, but the lack of a proper interoperability system. To streamline data interoperability and do away with information blocking, the Office of the National Coordinator for Health IT and the Centers for Medicare and Medicaid have issued rules mentioning the interoperable data and technology standards for sharing records between patients, doctors and payers. After a few delays, the rules are finally expected to kick in by April this year.
- Employing a vendor for the data collection drive is the preferred route of many payers. But how good is this mode? With increase in interoperability, more complicated data types will be needed as part of the essential health information of a patient. So, can each vendor handle advanced data? Scramble for information gives birth to startups. But payers have no means to verify whether patient data is being handled with care by startups without a track record. Insurers must push vendors to offer support services for integration into your enterprise systems. Besides, a well-defined service agreement with the vendor should be the first step for the payer.