The adage ‘knowledge is power’ has never been truer for the healthcare industry. I believe we are on the cusp of a revolution in healthcare and each of us plays a pivotal role in helping move this transformation forward. What exactly is powering this revolution? Data.
That shouldn’t come as a surprise to any of us. Data is quite literally everywhere. At work when we’re sending emails and sharing files. At home when we’re scrolling the web and getting the latest news. When we sleep, eat, or talk (cue Amazon Alexa), there’s a good chance data is involved. And, in the last few years, it’s permeated the world of healthcare faster than ever.
Take machine-readable files (MRFs), for example. As of July 1, 2022, the Transparency in Coverage Rule requires health plans to publish MRFs containing pricing information for in- and out-of-network items and services. MRFs have given us access to trillions of data points. For context, at Zelis, we download and process about 27 terabytes of MRF data each month for just the top four payers. Considering one terabyte is equal to 130,000 digital photos, imagine more than 3.5 million digital photos because that’s 27 terabytes! MRFs are a treasure trove of information but they’re complicated and daunting on their own – they’re not for you or me to read and understand – hence the name. However, MRFs paired with additional resources such as demographic data open the door to better network performance and lower healthcare costs.
Using data to improve the member experience.
It’s not an easy experience to see a doctor these days. Think back to your last trip to the doctor, and you can probably recall at least one part of the visit that was frustrating (not to mention the confusion and complexity after the appointment). Even important tasks like getting bloodwork or finding a new provider get wrapped up in policies and procedures.
Transforming the healthcare consumer experience requires collaboration among all of us. More and more, consumers expect clarity and control of their healthcare. The onus is on us as payers, providers and solutions partners to enable improved care decisions and to generate costs savings and opportunities for them. It starts with data, taking the information available to us and creating solutions that make the healthcare experience easier.
Our team at Zelis is working hard to put these goals into practice. We’re aggregating and analyzing data and putting it back into the hands of payers, providers, and consumers. More specifically, Zelis is optimizing data to help payers easily assess, benchmark and create high-performing networks based on costs, access and quality. For providers, we’ve developed a comprehensive payments platform that streamlines multiple transaction streams and data.
As for healthcare consumers, in addition to a healthcare navigation and shopping service that helps with selecting the best care option at lower costs, we’ve also harnessed data to make provider searches and out-of-pocket cost estimates and personalized cost information accessible. Also, we can use MRF data to provide consumers with estimated costs when the historical cost for a specific medical procedure (e.g., knee arthroscopic surgery) they’re considering isn’t available through claims data. Now, healthcare consumers can have a more holistic view of cost of care and make better, more informed financial decisions before getting care.
No matter where you are in the healthcare cycle, we’ve made a commitment to turn messy data into actionable insights. My hope is that we can reverse the story for consumers by turning the confusing world of healthcare on its head. More than anything, we want to reduce the frustration and friction associated with healthcare.
Ensuring privacy amid the churn of data.
As Spiderman’s Uncle Ben once said (yes, a quick nod to a fictional character), with great power comes great responsibility. While this data is monumental to our industry, securing the data is more important than ever before.
Healthcare isn’t immune to cybercrime. In fact, of every industry, healthcare has reported the most expensive data breaches for 13 years running, with an average of $10.9 million.
Cybercriminals recognize the potential here just like we do, and finding the right balance between modernizing the healthcare financial experience and protecting patient information is key.
But I believe we can have our cake and eat it too. Our recent partnership with Google is a great example of that. Healthcare consumers can securely save their health insurance ID cards digitally in Google Wallet, using fingerprint, PIN, or other protected methods to add, view, and use their card. This is how modernizing healthcare can work alongside protecting valuable data.
Welcome the innovation.
The complex network of data points and solutions are far from simple, but it’s that intricately woven web that brought us to where we are today. To a place where consumers feel safe and empowered to get the care they need. To a place where providers have the resources to connect with health plans, and a place where health plans can drive competitive change in the market to lower costs for their members.
Protecting consumer privacy will always be at the forefront of modernizing healthcare. And as technology continues to advance, so does our potential to embrace the data revolution. This is a game-changer. Welcome it. Charge full speed ahead. Consumers everywhere are counting on it.
If you’re not sure where to start, I’ll offer a shameless plug. We do have people who can help you understand how to leverage all that data. You can connect with them here.
