Case Study
Accelerating healthcare interoperability: Engineering a clinical data pipeline for the future
OUR CLIENT
Our client is a Fortune 500 healthcare payer operating in all 50 states in the U.S.
THE CHALLENGE
Siloed data, weakened data sets
The ongoing shift to value-based care puts data at the epicenter of change. The ability to power real-time analytics and clinical decision support is critical for the best patient care and population health outcomes. Our client faced the challenge of improving access to ever-increasing volumes of data across the care continuum to help promote better patient and population health and facilitate the right patient care. Our client needed help with their core workflows, like risk adjustment (prospective and retrospective risk adjustment), cost of care (how to reduce the cost of care), and regulatory (HEDIS and STARS rating). They also needed to identify the most at-risk populations to help forecast future care demands. To do this, our client turned to UST to generate a rich data stream incorporating claims, clinical data, SDOH, and ancillary data.
THE TRANSFORMATION
Data ingestion and interoperability
UST’s interoperability practice, with seasoned CCDA, HL7, and FHIR experts, delivered a harmonious health data exchange. Working with the provider partners identified by the client, we created shared access to clinical and claims data using a data pipeline.
We engaged a variety of technical resources to establish CCDA, HL7 and FHIR-based data connections. These could ingest data from Epic EHR, state and national immunization registries, and health information exchanges along with claims/utilization data and SDoH data. This data stream provides 360-degree views for a more holistic look at the patient’s health record. We created a custom HL7 interface, data warehousing, and downstream processing for analytical reporting. We connected with over 100 organizations via various modalities.
THE IMPACT
Holistic views, enhanced care
UST’s solutions enhanced access to the right data and care coordination for the client and provided real-time data insights while decreasing administrative burdens. Since the implementation of customized data pipelines, our client has connected with most of the Medicare population in the U.S. Downstream data processes are now in place to facilitate prior authorization reviews, medication care gaps, HEDIS gaps, risk adjustment HCC, and case management workflows.
EXPERTISE AND RESOURCES
Learn more about the expertise and resources that helped us achieve success on this project.
Interoperability for Healthcare.
Healthcare Consulting Services & Transformation Solutions - UST