Sense Corp client, a healthcare delivery network, that specializes in providing services for Medicare-eligible patients, wanted to improve reporting to provide their physicians with an accurate way to measure patient outcomes in accordance with their care model. Sophisticated application owners had an excellent use case to create a data warehouse, but the definitions and data only met risk management needs and did not address the overall goal of providing physicians an accurate way to measure patient outcomes.
In the current state, data was collected from over 90 data sources with disparate information. Data challenges included:
- Multiple access points for users
- Data discrepancies between systems
- Minimal data controls (users had the ability to modify data in multiple databases)
- No IT owner responsible for overall data quality
- High operational support costs
These issues created distrust of reporting provided to the physicians. The distrust was exacerbated by the fact that the health service provider was facing obstacles and delays implementing a new auto-adjudicate claims system.
It was critical for Sense Corp to understand the overall problem and client objectives when developing the solution. Our team could have easily created a data warehouse that met the needs of the risk assessment team, but it would only address about 60 percent of the physician reporting needs. The solution would need to have all business units come to the table (including physicians) to ensure data was accurate, timely, and actionable.
With goals and objectives outlined in a Strategic Assessment and Roadmap (provided by Sense Corp), the service provider was ready to pursue an Enterprise Data Warehouse build.
Solution and Methodology
Sense Corp leveraged a two-prong approach, gathering requirements of ultimate reporting needs, while also applying expertise to healthcare data modeling and build. It became apparent that the immediate need was to provide accurate atomic level data. The initial priority was to build an operational data store (ODS) that provided the business a comprehensive but granular level of member, provider, disease management, eligibility, and overall clinical data.
Using an iterative approach, Sense Corp developed key subject areas over six core phases. The approach allowed the business to realize immediate value prior to the data warehouse completion.
The EDW build leveraged SQL Server Integration Services (SSIS) to build the ETL from the Legacy Claims system, new claims system, disease management, utilization management, Center of Medicare and Medicaid Services (CMS) files, and risk assessment tool.
- Business Requirements
- Technical Requirements
- Source to Target Mappings
- Data Dictionary
Knowledge Transition Approach
As subject areas within the ODS layer (EDW Atomic) were built out, the Sense Corp team developed a roadshow of lunch-and-learns to show how to connect to the EDW Atomic via various query tools, including SQL Server, QlikView, Access, and Excel (via OBDC).
The build established the foundation for a centralized hub of data coming from multiple data sources and resulted in a significant shift in the way physicians and business collaborated to meet the goals of the care model. Benefits of the EDW build became apparent when care model results noticeably shifted.
Enterprise Data Warehouse Highlights
- Quality measures – Healthcare Effectiveness Data and Information Set (HEDIS) scores
- 2011 to 2012 saw an overall 20 percent increase, with some measures increasing as high as 65 percent.
- 2012 to 2013 saw an additional overall 10 percent increase.
- Physician engagement
- Through the Physicians Reporting Package, physicians could for the first time see how well they tracked to all quality measures.
- The solution provided granularity to pinpoint missing preventive tests and procedures.
- Physicians became a part of the decision making.
- Data was now used as a part of the toolkit for the Care Model.
Overall, the effort brought a significant shift to the collaboration between the physicians and the business, helping meet the goals outlined in the care model.
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