Collibra helps Envision Healthcare and its patients tackle insurance claim issues
Collibra helps Envision Healthcare and its patients tackle insurance claim issues
There is a problem brewing in U.S. healthcare; insurance-claim denials are increasing. In February 2023, the independent health research organization, KFF, found that HealthCare.gov issuers denied 17% of in-network claims in 2021 and the number seems to be ever-increasing. However, Envision Healthcare, a medical group providing services to 30 million U.S. patients a year, is using data governance to tackle the problem and drive forward value-based healthcare. Using Collibra as the foundation of its data governance program, Envision has cut the number of instances where data anomalies can lead to health insurance-claim denials.
Goal
Delivering value-based care
In December 2022, Rich Sanders, VP of Innovation at Envision Healthcare, said “the core of value-based delivery is applying clinical knowledge, obtaining a better understanding of the data and empowering clinical decision-making.” He explained, “These kinds of innovations are subtle—they may not be recognizable to the patient during a visit, but they will make a difference in outcomes.” Value-based healthcare is using resources more effectively to achieve better results for patients.
This shift in healthcare drove Envision to consider how data could help deliver value-based care, as well as address challenges like reducing waste, improving revenue capture and tackling the growing problem of claim denials. As a leading national medical group with over 1,000 sites across the U.S. and 25,000 clinicians delivering a broad range of healthcare services, Envision Healthcare readily embraced the challenge and responsibility.
The main issue facing Envision was not lack of data, but rather improving the quality, understanding and management of the data. Healthcare providers often have to control disconnected information because individuals touch healthcare services in multiple ways. Data is collected at every touchpoint, but there are often gaps or mismatches.
“There are many different ERP systems and applications used by hospitals and clinics, and not all of them talk to each other,” said Roy Schmidt, Program Manager, Data Governance, IT Data Manager & Enterprise Architect. “But ultimately it comes down to people. If I go into the ER, reception enters information about me and so does a clerk during treatment. But if my middle initial is missing or date of birth is incorrect, you have two systems that cannot recognize me as the same person.”
Strategy
50 data collection systems
Within Envision, data governance is formalizing the processes and roles that are already in place to ensure trust in data. “One of the first things we did was interview data citizens across all of our functional groups and we uncovered 50 different data entry and collection systems,” revealed Schmidt. “In radiology for instance, there were five different data delivery methods including PDFs and spreadsheets.”
Envision looked at several data governance solutions but ultimately chose Collibra. The company used the Collibra Rapid Start Implementation Service to enable best-practice deployment. “In choosing and rolling out Collibra, we learned to let the vendor help you,” recalled Schmidt. “Many pay lip service about making you successful; Collibra proved it. The company advised and guided us through the implementation process. There were times we worried that the Collibra team was the ‘tail wagging the dog’, but we leaned in and let them guide us to do the things we might not have known to do.”
Collibra encouraged Envision to conduct a maturity assessment, re-look at use cases, and develop a success and adoption plan. “We learned so much more about our own use cases even though we thought we had already defined them,” added Schmidt. “Every person we have dealt with at Collibra has been a special advocate for us.”
The data governance program at Envision uses the Collibra Data Intelligence Cloud solution running on AWS and they are using the Data Quality & Observability, Data Catalog, Data Governance and Data Lineage capabilities. Collibra is integrated with several complementary applications such as Microsoft SQL Server and Tableau.
Before deploying a solution, Envision invested time in preparing and setting expectations for the business. “We did not want to fly in with an IT app,” explained Schmidt. “I spent two months with numerous teams, listening to their pain points. Then another two months with technical stakeholders prepping data and two more weeks with data owners. But they did not want anyone touching their data. My advice is, engage with data owners up front and emphasize that data governance is about metadata, not the data itself.”
Solution
51 quality metrics
Once Collibra was up and running, Envision used Data Catalog and Data Quality & Observability to ingest data warehouse documentation, understand the data and develop an up-to-date business glossary. This enables users to search, find and interpret data. For instance, a clinician looking at a Tableau dashboard uses Collibra to research term definitions, find data owners and map lineage.
The data that Envision gathers includes administrative data such as HR, financial, credentials, scheduling, payroll and clinical. To manage quality of care, the company has 51 KPIs incorporated into Collibra which measure aspects such as treatment outcomes, success of stroke treatments, or number of sepsis cases by clinician, site or shift.
Data governance at Envision does not fix or clean up the data, it is there to highlight problems and issues. For example, there is a 72-hour-returns KPI which tracks whether a patient needs to come back to a clinic within 72 hours. Data governance looks for consistency across all ER facilities and signals if there are missing or incorrect data fields or attributes. A clinic with an unusually high number of 72-hour-returns rate might require investigation.
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