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August 7, 2012

Where’s the Real Value in All That Health Data?

As more parts of our lives “go digital”, the collection of data related to our transactions, interests, and other preferences continues to grow exponentially.

Many commercial enterprises have demonstrated that the ability to manage and even monetize such data provides a powerful competitive advantage. In fact, it’s that principle of Digital Marketing which allows for the delivery of unique personalized experiences for consumers online.  Our health data is no exception.

The health care industry has been criticized for being a laggard when it comes to tapping the wealth of information that’s often locked away in terabytes of stored data, both structured and unstructured, compounding with every insurance claim or provider interaction.  That’s changing, however, as innovative solutions that have modernized industries like travel, financial services, and others are gradually being leveraged throughout the healthcare ecosystem.


Recently, at the Adobe-sponsored State Healthcare IT Connect Summit, I met with executives from state and federal agencies as well as leaders of private sector health organizations to explore the key role of IT in identifying trends, cutting costs, and saving lives.

Three recurring use cases for transforming this accumulating data into actionable knowledge emerged during our meetings:

  • Improved Clinical Decision-Making

When health care providers are empowered with the ability to visually evaluate factors about a patient’s medical history and health status from multiple data sources in real-time, the measurable results include improved outcomes, personalized care, and more efficient use of resources. In fact, a recent Black Book Rankings survey revealed that clinical analytics tools have become a top priority for hospital IT leaders who are moving towards accountable care adoption.

  • Reduced Fraud, Waste and Abuse

Along with clinical innovations and technological advancements, the core business of healthcare is also evolving to control costs and maintain affordability.   In Medicare alone, fraud is estimated to cost taxpayers and consumers about $60 billion a year. That number quickly escalates when also considering fraudulent activity in Medicaid and private payer networks.

Last month, the Department of Health and Human Services announced a ground-breaking initiative between private and public sectors that will use analytics to identify suspicious patterns of behavior that could indicate fraud in billings and claims data. This will allow for fraud detection between organizations that otherwise may have gone unnoticed, such as when a doctor bills for more than 24 hours in a day or regularly overbills for a particular code. Participating law enforcement organizations include the FBI, the HHS Inspector General’s Office, the Justice Department, and state and private insurance fraud control units.

  • Integrated Eligibility, Enrollment, and Operations across agencies

As governments strive to eliminate redundant workflows and reduce costly errors associated with manual data entry, many have begun to consolidate IT operations and share data between agencies.  This allows them to build a more accurate and comprehensive profile of the citizens they serve in order to provide more personalized service.  It also minimizes the need for constituents to provide unnecessary information every time they interact with the agencies.  Instead, user data may be cross-referenced and pre-populated in forms and other processes based on validated information already on hand.  A typical example is the forming model of collaboration between federal and state agencies as a result of the Affordable Care Act. As applicants apply for health benefits, a secure network of real-time data communication will verify identity, validate citizenship status, determine eligibility, confirm income, and establish an account.  And those are just the very first steps.


Today, countless agencies and enterprises are spending millions of dollars annually to archive their proliferating mountains of data. That same data has the potential to offer valuable insights into the behaviors and needs of the citizens and customers they serve.  And in the case of healthcare, the data can unlock actionable knowledge to improve outcomes and save lives.

In order to build a sustainable system of care for everyone, including millions of newly insured citizens, agencies are realizing they can no longer afford to maintain a status quo “store and ignore” data strategy.