Master Data
Management

Introduction

While healthcare has always been dependent on data, the transition to value-based reimbursement dramatically raises the stakes. Specifically, it requires a degree of integration between data sources that previously was not required under a fee-for services regime. It also raises the ante for data quality. It is not enough to simply bring disparate sources of data together and hope that the inherent variability of the sources is somehow reconciled. To be useful, integrated data must adhere to a common set of standards and nomenclature so that it can be effectively put to work. This is especially critical for Accountable Care Organizations (ACOs). One approach to this issue is the deployment of a Master Data Management system (MDM). An MDM solution allows a healthcare enterprise to standardize and pool critical data into a single database, providing a common point of reference for ACO reporting and management. This white paper discusses 7 questions to consider in preparing for and implementing an MDM for ACOs.

• IS YOUR DATA READY?
  To be effective, an ACO must not only modify clinical operational practices— the way care is provided—but it also needs to report on the outcomes of these modifications. Did they work? Specifically, were the modifications effective in terms of the requirements of the ACO? A primary source of data to answer these questions resides with payers in the form of claims, eligibility and pharmacy benefits information. While data standards exist for these items, the way they are implemented at the individual payer level is highly variable. Managing this variability is not only labor intensive, but potentially impedes the ability of an ACO to effectively assess its performance. Master Data Management directly addresses the issue of data quality and data variability by introducing processes and technology that standardize and normalize large data sets coming from multiple data sources. These normalized data sets provide the basis for ACO performance analysis and management.
• ARE YOUR PEOPLE READY?
  Implementing a Master Data Management solution is both a technical and organizational endeavor. Issues of data stewardship and data governance assume a new level of importance when pooling and transforming data from multiple sources. The MDM needs to reflect both ACO requirements, as well as the practical considerations of the data sources. As a result, an MDM team representing the diverse stakeholders of the organization must be established to oversee the design and implementation of the solution. Additionally, once the MDM is in place, staff and leadership are required to manage the system from both an operational and data stewardship perspective.
• DO YOU UNDERSTAND YOUR REQUIREMENTS?
  Since the primary use case for MDM (at least within the context of an ACO) is providing for data for reporting and other clinical or financial tools, the first step is understanding these requirements. This means bringing together ACO subject matter experts, business owners of third party tools that will consume the MDM data, and IT staff that will be tasked with managing it. MDM service providers can be very helpful in this process by providing an outside, objective perspective. The combination of internal and external teams help facilitate a thorough vetting of the core assumptions and requirements of the project.
• WHAT TOOLS AND SERVICES DO YOU NEED? AND WHERE WILL YOU GET THEM?
  An MDM is not an off-the-shelf project. It is highly customized to meet an organization’s specific requirements. As a result, an MDM is typically deployed by third party service providers that bring together a unique combination of healthcare domain knowledge, data integration tools and project management skills. Here are some of the characteristics that one should consider in an MDM service provider.

What Does Implementation Look Like? How Long Does It Take?

While an MDM project will be new to most organizations, the implementation steps are like other IT projects. They include:

Defining Requirements

One of the biggest areas of impact for automation is simply in claims processing. Payer websites allow for claims data on the payer’s risk to be pulled and stored into your systems. This can be done manually, using multiple FTEs to navigate, pull, save, identify issues, and all the rest, or it can be done automatically, in some cases freeing up full teams of people to be utilized in more value add roles. The CAQH estimates the use of online portals to manage the processing of transactions increased 55% in 2017. What’s more, setting up a claims processing automation solution facilitates an improved ability to analyze the claims being processed.

Analysis of Existing IT infrastructure

An MDM is an add-on to an existing IT infrastructure, not only consuming and transforming data but also populating third party tools. Mapping the existing systems and how they will interact with the MDM provides a practical guide to deployment.

In order to realize an efficiency gain on a process like this, you’ll want to consider how to successfully employ technology to manage the flow of claims. The most crucial part of functionality you’ll want is the automated distribution of claims to Managed Care Coordinators (MCCs). A robust solution would also give managers the ability to manage the distribution by editing the members on a given distribution list, reassign claims for unexpected conflicts, and exclude members from receiving claims for certain periods (e.g. for PTO). Additionally, automating this workflow facilitates additional business intelligence on the process: you’ll be able to more closely manage turnaround times, get insight into high or low volume periods, and see how efficiently your team members are reviewing claims. All of these things will help keep claims moving without having to rely on clunky Excel workbooks.

Plan

The plan brings together your findings into a blueprint for deployment. The duration of the project is related to its complexity (i.e. the number of data feeds, variability among data sources, scope of requirements, and the status of the IT infrastructure). Project timelines can vary from 4 to 18 months. An MDM project plan should be a detailed but dynamic document, subject to modifications as issues present themselves during deployment.

Implementation

Making the transition from planning to implementation immediately tests all the core assumptions about the project. In the early stages, implementation offers the opportunities to refine and hone working relationships, both internally and with third party service providers. Practical considerations reign, such as providing data access to third party service providers (and completing required paperwork) and overcoming the inevitable system obstacles that are part of probing a complex and secure IT system. Iterations are likely, putting a premium on securing nimble and agile internal teams and external service providers.

How Much Will This Project Cost?

Third Party Service and Software Providers

A vendor quote should provide a clear understanding of how it is priced (project vs. hours), what is included (list of services), what is not included and change order management if the scope of the project changes. Additional fees for software and related maintenance should be included.

IT Expense

MDM is a processing and storage intensive system that may exceed the capabilities of your current resources. Your MDM service provider should be able help you scope IT requirements so that you can budget and procure.

Internal Resources

An MDM project requires internal leadership and active participation of key staff members, particularly in the planning stage where requirements are being scoped and defined. As the heavy lifting of planning transitions to implementation, project leads and staff will need to be allocated to work in concert with third party service providers. Since the plan will be iterative based on implementation activity, overall project leadership needs to remain in place through go-live, ultimately transitioning to an active support mode (data stewardship and governance) charged with maintaining the health and vitality of the MDM system.

What Is the Return on Investment?

The cost of low quality data is very high. Managing and correcting exceptions is labor intensive and often complex. Persistent data anomalies also undermine confidence in the data and may constrain the organization in its ability to comply with ACO reporting or management requirements. An MDM solution promises higher quality data with less rework, more efficient data management tools and a foundation for improved ACO management and reporting. The net return: lower labor costs for exception handling and more effective performance against ACO contracts. While ultimately it is the success of clinical operations that will determine return on ACO contracts, it is impossible to assess clinical effectiveness without high-quality data. The two are inextricably entwined.