Who has a stake in the payer journey from data islands to big data?

This is the 2nd blog in our series “From data diffusion to insights with enterprise-wide data strategy”

zahoor-1200x628An interview with Zahoor Elahi, Senior Vice President of Strategic Product Management, Optum

Health plans and health systems are ripe for disruption. Big-tech continues to significantly invest in health, wellness and life sciences. They are using technologies such as cloud, artificial intelligence (AI) and machine learning to automate business analytics. What they don’t have (yet) is the preponderance of health expertise and data that health plan and health systems have. This includes claims and clinical, with labs, pharmacy and member demographic data completing the picture.

This is the second blog of our four-part series on enterprise data strategy and platforms. Here, Zahoor Elahi discusses health plan leaders’ roles in the shift to big data. Zahoor is senior vice president of Strategic Product Management at Optum.

Q1: What is the role of an enterprise data platform (EDP) in building a holistic approach to health care?

An enterprise data platform creates a “spot in the cloud” for claims and clinical data. From there, we have a whole-person view of each member as well as prescriptive and predictive insights to guide actions in care delivery. The promise of precision medicine is that it allows us to contextualize data to recognize adverse events or deteriorating patient conditions before they occur. Precision medicine provides a clearer picture of patients’ underlying medical conditions, past treatments, gaps in care, medications prescribed and future care needs.

Q2: How does an EDP support care coordination?

The provider and patient are at the center of care coordination and outcome-driven health care.

The payer holds the claims history that can propel individualized medicine and improve member health. Claims contain the disease codes, days at facility, pharmacy and specialty data. This information is as important as clinical data and more important than simple transactional data. When we merge these data sets, we can create context around the individual, a record of health and make evidence-based predictions that providers can act upon.

In health care, with its abundant data, gaps in patient data often frustrate providers and patients. And the path that data has to travel to reach point of care can be convoluted. In the age of optimization, an enterprise data platform is the key to unlocking data silos within the payer organization and the broader health system. This enables interoperability and the ability to deliver the right information at the right time and place.

Q3: What roles do health plan leaders play in moving from legacy to modern data and analytics systems?

In my experience, senior leaders outside the realm of analytics are somewhat unfamiliar with data analytics products. They may not know how to incorporate insights into health care decision-making. Their roles and goals will begin to overlap during and following the process of optimizing  enterprise data. This means it’s important to bring a multidisciplinary team to the table from the outset.

CIO consumer focused graphic (1)

The CIO plays a dual role of change agent and technology leader. He or she will serve as champion of cloud capabilities and educate leadership on the computational power of big-data platforms. The CIO leads technical evaluation and implementation and is responsible for expanding interoperability, scalability and overall performance. The CIO also has to anticipate the data needs of the chief medical officer, operating officer and data scientist as data is created in the EDP.

The CIO is responsible for expanding interoperability, scalability and overall performance. As the holder of data, the CIO ensures the provenance and quality of data. He or she is responsible for where it resides, as well as data security and quality. The CIO must also serve as champion for cloud competencies and be able to anticipate the future data needs of the CMO, the COO and the data scientist as data are created in the EDP.

The COO is interested in driving new value from data that can, for example, lower administrative costs and reduce waste in health care. He or she will also bring together disparate departments and help drive adoption of an enterprise data strategy approach with those goals in mind.

Chief data scientists or analytics teams understand how data intersects to create accurate, predictive recommendations for decision support and risk management. They are responsible for understanding consumer preferences and needs — in the increasingly consumer-driven health marketplace.

The chief medical officer in the payer organization focuses on:

  • Keeping members out of expensive care situations
  • Identifying and supporting high-performing providers
  • Protecting the payer organization from risk.

However, the CMO may not understand the data sets and analytics necessary to manage to these goals.

The CFO leads investment in decision support and data quality. This includes  acquiring the technology and expertise to create a coherent, integrated and sustainable platform from which the organization can derive and operationalize high-quality insights.

Payer relevance relies heavily on its ability to utilize data to create new health value. The CIO imperative is to lead the way to an enterprise view of data.

Q4: Why now?

There is something bigger happening in the health care ecosystem that is compelling us to better orchestrate health services and to better utilize health care data. To coordinate better care and improve consumer satisfaction, providers and payers must focus on delivering a contextualized view of each patient/member, with data drawn from multiple sources. It’s not enough to have a partial view of a patient or member. There is an urgent need to:

  • Approach health care as a team
  • Use claims and clinical data sets
  • Prepare for emerging data sources

Together, we can improve performance, decrease costs and improve the customer experience.

An enterprise data platform delivered by a partner focused on health care works to close the holes and lag time in the health care system. This enables insights when they’re needed to affect individual and population health.

Zahoor Elahi talks about payers being the new care coordinators due to the power of data. 

Q5: How does an enterprise data platform rank in the CIO’s list of priorities?

It’s likely that the CIO won’t come out of the gate searching for an enterprise data platform. But solving the big issues — such as cutting medical spend while improving care quality — requires an analytical approach. The enterprise data platform powers the prescriptive and predictive insights they need to refine their business for the new era.

Resources:

Visit Optum.com/CIO to learn more about who has a stake in the payer journey from data islands to big data.

Catch up now on the entire series: From data diffusion to insights with enterprise-wide data strategy

About the Author:

Zahoor Elahi is senior vice president of Strategic Product Management at Optum. He develops end-to-end health care IT and business process solutions. Zahoor brings thought leadership, ideation, and market intelligence to product development to help clients transform the health care ecosystem and derive maximum value.

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