Reliable and Secure Healthcare Integration Services

Data Integration Challenges for ACOs Effective use of data, including collecting, analyzing, and turning it into actionable information with advanced analytics for clinicians, is critical to the success of ACOs in VBC. Forming a complete picture of population health is one important aspect of this task. To achieve this objective, ACOs bring together data from claims, EHRs, state health exchanges, hospital EDT feeds, eligibility verification systems, and more sources.  ACOs must ensure they are receiving the right data elements in a timely manner, figuring out how to best filter and combine disparate data sets, and turning data into digestible, actionable information to focus clinicians.  However, the lack of data standardization makes it hard to seamlessly share data for VBC.  Having ACO participants on different EHRs is also a challenge for many, but for those using the same EHR, there are still hurdles due to different versions of the same EHR or customization nuances.   ACOs also struggled to find and retain high caliber staff who are adept at managing data to support the ACO. Staff turnover creates knowledge gaps, especially when losing key employees involved in building or customizing platforms. Benefits of Data Integration for ACOS Creating a centralized analytical system through data integration allows ACOs to gradually improve the accuracy of analysis and automate processes. ACOs, despite spending several years developing a custom analytical platform that consolidates data from EHRs, claims, and other sources, are now happy with their strong ability to provide physicians with precise data to support clinical decisions. Data integration enables the effective identification of rising-risk patients, preventing their conditions from worsening, reducing treatment costs, and improving patient outcomes. Data from EHRs, claims, and lab systems for risk stratification allows ACOs to focus on rising-risk patients rather than solely on the sickest patients whose conditions are harder to change. Data Integration to Support Leadership Decisions and Physician Practices Integrating data from multiple sources enables analytics teams to provide leadership with accurate, comprehensive reports for informed decision-making at the management level. Some ACOs even give analytics an equal role in leadership alongside finance and operations. Reliable data integration ensures the timely delivery of information relevant to individual physicians, increasing trust in analytics and encouraging its use in clinical practice. Physicians may receive regular reports that include key performance indicators tied to ACO goals. This allows them to focus on specific improvements in their practice. Data Integration to Optimize Treatment Approaches Integrating data on costs and clinical outcomes helps identify economically inefficient treatment methods and implement alternative solutions that reduce expenses without compromising quality. Some ACOs report discovering that patients were receiving expensive injectable treatments for anemia. Data comparison revealed that an alternative method was equally effective but significantly cheaper, reducing treatment costs. Data Integration to Reveal and Address Social Determinants of Health Integrating social data with medical data helps identify and address barriers preventing patients from accessing necessary care. Some ACOs reported that their analysts identified rural patients missing dialysis appointments due to a lack of transportation, leading to severe complications. They were able to implement targeted interventions by providing transportation services, which resolved the issue. Data Integration to Detect and Prevent Fraud Integrating data from various providers and insurers helps identify anomalies and cases of fraud, saving significant resources for ACOs. The Institute for Accountable Care analyzed Medicare data and discovered a 20-fold increase in catheter expenditures over two years. This led to an investigation and a reduction in unjustified expenses. Data Integration for Accurate Risk Scoring Risk data plays a critical role in financial calculations and care management.  The ability to prevent MSSP risk scores from declining by stratifying risk to identify patients with the highest needs, allocating resources accordingly, focusing on rising-risk patients to prevent them from getting sicker, and prospectively risk-stratifying patients (based on characteristics such as past patterns of high utilization, recent inpatient stays, frequent ED visits, predicted high spending, risk of hospitalization, and multiple chronic conditions) requires combining data from various systems.  Without high-quality data integration, such processes would be extremely difficult or impossible. How Belitsoft Can Help Belitsoft is a data analytics software development and consulting vendor that helps data analytics vendors support ACOs in reaching their goals by providing engineering and consulting services to: Integrate disparate data sources Develop analytic platforms and data warehouses Automate reporting, moving away from manual Excel reports Create visualization through tools like Tableau, making raw data from various payers comparable across traditional Medicare and Medicare Advantage and much more Enrich data with benchmarking tools, grouped clinical data, and flagged avoidable ED visits and much more

Insurers may deny a high percentage of claims, many of which are never resubmitted, resulting in losses of tens of millions of dollars. Most denials are recoverable and preventable, but only with proper root cause analysis of claims denials. Without robust analytics tools, the percentage of the organization’s denial rate exceeds best practice multiple times, and healthcare systems continue losing money. It’s necessary to develop advanced data capabilities to proactively identify issues early in the revenue cycle process. Challenges on the Way to Decreased Denial Rates Revenue cycles are complicated and variable for large networks with multiple facilities. Billing processes and requirements of hospitals and physician practices within a single healthcare system are peculiar. Different insurance companies offer various policies. All of this can lead to inconsistencies in handling claims and result in defects and waste.  The list of issues is often related to processes and technologies. Issues with Technology Lack of tools to proactively determine initial issues that appear early in the process of the revenue cycle to avoid repeating errors and improve cash flow  Inefficient utilization of the available technologies and absence of interaction between multiple IT systems, which results in difficulties with data analysis and unnecessary duplication of work Insufficient detailing of the available EHR reports, difficulties with generating them, and finding precise issues of denials  Process-Related Challenges Wide variation in the way the staff performs its functions   Unequal distribution of the workload and tiresome manual data entry Low speed of collecting detailed insurance and demographic information that is essential at the front end for preventing denials  The time-consuming process of selecting the right plan registration for complex cases due to lengthy documentation Missed insurance authorizations when patients stay in the hospital for a period longer than the initial authorization Organizational and Communication Gaps Lack of training among clinical and operational executives about the correlation between their performance and the general denial rate  Miscommunication between the financial teams and clinical and operational leaders, as the former struggle with preparing user-friendly reports with clear recommendations Strategic Weaknesses Ineffective embracing the whole problem at a time instead of concentrating on specific target areas and benefiting from incremental improvements  Absence of a holistic improvement plan, based on data, that would involve clinical, operational, and financial teams to address the problem.  Features of the Claims Analytics Solutions to Save Dollars To decrease the denial rate, healthcare organizations implement claims analytics solutions powered by modern data warehouses technologies, which consolidate data using ETL processes. It provides organizations with the following capabilities: Creating interactive visualizations for in-depth data analysis to generate more actionable insights compared to legacy Excel-based and embedded EHR reports Analyzing the denials, identifying their root causes, and exploring peculiar issues Visualizing and exploring the information regarding denial trends over certain periods of time, denial age, types, current procedural terminology (CPT) codes, as well as payers, divisions, and account classes Developing a standardized set of metrics to create a framework for understanding what exact performance improvements all the stakeholders expect and how to measure them. Organizational Measures to Implement Claims Analytics To achieve the best results with the new software, some organizational measures should be taken into consideration. Healthcare systems should pay attention to the following supporting activities: It is recommended for organization leaders to prepare the ground for commitment and advocate the idea of reducing denial claims The CEO, CFO, and COO should cooperate to make addressing claim denials a top priority, raise awareness about the problem in the organization, and assign a dedicated person to drive the initiatives forward An organization could also hire or train a dedicated denials analysis team that will learn denial trends, conduct root cause analysis, determine patterns, and measure opportunities for improvement over time It would be beneficial for executives to explain their vision and tasks to clinicians and demonstrate the impact of the revenue cycle on patient experience. Clinicians should realize that proper initial billing shows their caring attitude toward patients  Leaders should cease concentrating on one-time tasks. It is better to come up with a strategy for steady improvements with regular assessment and research and iteration of the Plan, Do, Check, and Act (PDCA) steps. What Benefits to Expect from Implementing Claims Analytics? By applying the claim analytics tool, as reported, organizations can gain the following results: Achieving a target that meets the best industry standard of denial rates Saving millions of dollars directly resulted from the reduction of denials  Gaining millions of dollars in annualized recurring benefit  Addressing inefficient workflows, processes, and manual entry through the PDCA approach that helps identify root causes and develop effective interventions  Identification of the root causes of claim denials in departments, where the leadership believed their processes had been effective Adoption of the initiatives across the organization with coherence and engagement thanks to visible and measurable analytics data Encouraging sustained improvements due to engaging operational leaders. How Belitsoft Can Help Belitsoft is a full-cycle software development and analytics consulting company that specializes in healthcare software development. We help top healthcare data analytics companies build robust data analytics platforms. For integrated data platforms developed to collect, store, process, and analyze large volumes of data from various sources (Electronic Medical Records, clinic management systems, laboratory systems, financial systems, etc.), we: Automate data processing workflows (cleansing, standardization, and normalization). Configure scalable data warehouses. Set up and implement analytical tools for creating dashboards, reports, and data visualizations. Ensure a high level of data security and compliance with healthcare regulations such as HIPAA. Integrate machine learning and AI into analytics. We also help build specialized analytical applications like Claims Analytics for:  Applying custom date filters to analyze specific timeframes Visualizing denial trends, including initial and current rates, and aging buckets in graphs and diagrams Aggregating and analysing denial reasons Highlighting key denial reports. If you're looking for expertise in data analytics, data integration, data infrastructure, data platforms, HL7 interfaces, workflow engineering, and development within cloud (AWS, Azure, Google Cloud), hybrid, or on-premises environments, we are ready to serve your needs. Contact us today to discuss your project requirements.