Success Story

Government Healthcare Compliance via MDM

Improving healthcare provider accuracy with MDM to align with governmental standards

The complete guide to selecting an MDM solution

Military healthcare, protecting those who serve

This company provides civilian healthcare to 6 million military personnel predominantly across the eastern United States. It facilitates access to civilian healthcare providers when military treatment facilities are overcapacity or unable to provide the needed services.

The company’s offering extends to both active-duty personnel and retirees. This dynamic sometimes results in dual benefits where qualified beneficiaries are eligible for both the company's and VA benefits.

The role of data, therefore, becomes paramount - from tracking provider networks comprising doctors, facilities, and groups to ensuring beneficiary data is accurate and accessible. The challenge in doing so escalates with the need to maintain accurate provider directories, a requirement stipulated in their contract with the US Government. Adhering to strict regulatory compliance is a must due to their indispensable service to military personnel.

Provider data at the center of tight government requirements

Scorecards serve as a quality and performance metric within government-regulated organizations. Showcasing an 'always green' status, symbolizes their persistent high-quality service. However, there was one metric consistently lingering in the red.

A strict government-set accuracy benchmark of 96% is a challenging task when the industry standard of 80% is considered excellent. The ‘red’ score for the provider directory meant that something had to change and fast.

A closer look into the issue revealed underlying problems with their data management practices. Instances where corrected provider information – such as an updated address or phone number – were being inadvertently overwritten by outdated data from nightly loads.

Business needs spearhead the call for better data management

Realizing the severity of their problem in data quality issues pervading crucial systems and processes, the organization embarked on a comprehensive review of their data.

They initiated grassroots SQL-query data quality checks to demystify the real scenario and gauge the depth of the data discrepancies. However, this manual data profiling, albeit revealing, was significantly time and resource-intensive. The P&O team struggled to understand how their data was being handled, transformed, and cleaned by IT processes.

The provider's directory instance consisted of over 3 million records, manual updates, and verifications, making it virtually impossible to sustain.

Despite its initial absence, a focused approach toward data quality became the preliminary step. But would that be enough?

The starting point: Finding the right approach to tackle their needs

Both the Provider Network Organization (the company's primary data management driver) and the IT department knew they needed a clearer, more user-friendly way to manage data and keep tabs on its quality and movement. The challenges P&O faced:

  • A clear roadmap of data flow.
  • User-friendly transformations.
  • Transparent data cleansing rules.

Highlighted a clear need for better data management.

This was the moment when the seeds of a robust data governance practice were planted, culminating in the creation of a dedicated team to overcome these data challenges. After multiple months of comprehensive research, the need was clearly defined: Implement intelligent matching and merging of data and ensure automated, batch, and eventually real-time data updates.

The company didn’t jump to quick fixes and patches. They took the time to explore and think through all their options. Master Data Management (MDM) stood out not just as a fix to their ongoing issues but as a strategy to significantly improve operational effectiveness and regulatory compliance.

The stage was set for a journey that had to start with implementing a Master Data Management (MDM) tool.

Combining Ataccama’s capabilities and support to help both business and technical users

From providing insightful white papers and materials to exemplifying their advisory capability in the MDM space, Ataccama stood out not just as a solution provider but as a prospective strategic partner stated the customer.

Usability across the knowledge spectrum:

Ataccama proved itself by showcasing a platform that is navigable and usable for both technical and non-technical users. The IT organization appreciated a tool that would not solely rely on their efforts, enabling a smoother adoption throughout the organization. In return, this accessibility did not require fighting to make stakeholders aware of Ataccama’s capabilities.

Support beyond software:

Apart from offering a robust MDM and data quality tool, Ataccama provided thorough training, consulting, and help with building their initial MDM model. This in-depth, hands-on assistance was pivotal for the organization’s small data governance team of 5 , enabling them to accelerate the implementation process and ensure it was aligned with their specific needs.

Aligning commercially and technologically:

The organization acknowledged that the low technical barriers to getting started, coupled with the opportunity to receive training and consulting help directly from Ataccama, shaped it as a commercially sensible option. The facilitation of a swift start without incurring a technological debt was a valuable proposition that distinguished Ataccama from other contenders.

Tangible ROI in weeks, not months!

In the complex world of data management, deriving tangible value speedily is imperative. Here are a couple of quick wins that the organization saw from the very beginning of the Ataccama rollout:

Swift operational effectiveness with automated data profiling

With Ataccama, the tiresome task of data profiling was substantially simplified. Leveraging the tool’s capabilities, what was once a manual, coding-intensive effort transformed into a straightforward, few-click process. This catalyzed the Data Governance team’s ability to navigate through data, pinpointing and amending issues with greater accuracy and speed.

Immediate improvements in regulatory compliance

Ataccama’s tool proved to be invaluable in swiftly enhancing compliance. The intuitive, user-friendly nature of the tool accelerated the problem-finding process for users within 2 weeks of implementation. It enabled people to scrutinize data quality scores at a column level, identify and manually rectify issues even before integrations were fully in place.

What’s next in the data governance journey?

Now that we've established the problem and how we helped solve it, let's see what we can learn from the company's next steps on their journey to better data management practices.

Expanding and elevating MDM & RDM implementations

While Provider MDM will continue to anchor their strategies, emerging data sources, particularly in the realm of beneficiary data, can potentially broaden the MDM scope. Concurrently, a more intricate RDM implementation aims to transition reference data from the mainframe to a contemporary, more agile solution. This shift toward an expansive RDM use case - managing pivotal elements like treatment codes - underscores a deliberate stride toward modernization.

Embedding AI in MDM for accelerated matching and merging

The future also harbors an exploration into infusing Artificial Intelligence (AI) within MDM, particularly in enhancing matching and merging processes. The deployment of AI recommendations expedites MDM processes, introducing a layer of intelligent automation that can amplify accuracy, efficiency, and overall data governance efficacy.

Continuation of the Ataccama partnership

As the company navigates through this intricate journey, the continuity and evolution of the partnership with Ataccama are pivotal. The demonstrated impact and the synergy of Ataccama’s solutions with the company’s objectives lay the groundwork for future collaboration. One such example is the potential to leverage the ONE platform for everything data management.

The complete guide to selecting an MDM solution

The complete guide to selecting an MDM solution

The complete guide to selecting an MDM solution

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