EXL Health delivers data management for value-based care

This case study discusses how EXL Health worked with a major U.S. healthcare provider to implement a new data architecture to better manage their value-based care model.

Healthcare providers and payers have not always shared the same goals. Traditionally, providers focused on improving care outcomes, while payers concentrated on reducing costs. What was good for one was not always good for the other. That relationship began to change as value-based care models – where providers are reimbursed based on the quality of care achieved instead of the volume of services delivered – became more prevalent in the healthcare market. As such, payers and providers now focus on many of the same goals of care delivery, patient outcomes and financial outcomes.

The Challenge

The healthcare organization faced challenges associated with meeting the goals of an integrated provider-payer organization while operating numerous hospitals, outpatient facilities, and an insurance division. The organization was striving to optimize care utilization, ensuring the right services are provided at the right time and at the right cost. A singular mission surfaced: to improve both operational and care efficiency on both the provider and payer fronts.

To achieve this mission, EXL Health worked with the healthcare system leaders to leverage data and analytics to identify the most vulnerable areas of need, many of which formerly flew under the radar. After identifying these issues, EXL Health drilled down to analyze more granular data to address more specific challenges in operating a value-based model.

EXL Health helped the healthcare system build a data management foundation as well as business analytics capabilities required to leverage data to identify, track, and trend issues. This allowed the healthcare system to solve problems associated with running a successful organization in today’s value-based world. More specifically, EXL Health worked with the leadership team to establish and maintain a data management and analytics infrastructure capable of addressing challenges associated with:

  • Government reporting
  • Supply chain tracking
  • Improved clinical care
  • Provider inpatient quality outcomes
  • Key measure improvement priorities
  • Reduction-of-harm events such as patient falls

The EXL difference

The healthcare system had previously purchased and implemented two information systems – one for provider data and one for payer information. As such, interoperability presented an ongoing challenge to establish a unified data architecture with integrated provider and payer data.

To address this issue, EXL Health worked with the healthcare system leadership team to complete an audit of their data usability and concluded that the data architecture was not acceptable due to several issues. EXL Health then worked with the healthcare organization to develop and implement a new data architecture that would better serve its goals.

EXL Health helped the healthcare organization build a data architecture that made it possible to leverage data analytics to address the challenges that the organization was facing. More specifically, EXL provided services and expertise to:

  • Build the requested analytics
  • Load data from various sources
  • Automate processes
  • Analyze data
  • Utilize custom dashboards and visualizations
  • Create custom key performance indicators

In addition, EXL Health ensured that the healthcare system’s data projects would succeed by:

  • Building a data mart where all data from both the provider and payer systems could converge.
  • Leveraging data at the same level of granularity, making it possible to further integrate information.
  • Utilizing the new data architecture to simplify reporting.
  • Building flexibility into the system, making it possible to change data granularity as needs evolved.
  • Relying on data analytics, intelligence, and reporting to provide stakeholders with timely information that empowered them to make business decisions, drive interventions and improve various metrics.

Why EXL Health?

At EXL Health, we are committed to a true partnership with our clients and are passionate about your success. Combining deep domain expertise with analytic insights and technology-enabled services, we transform how care is delivered, managed and paid. Leveraging Human Ingenuity, our work enables our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, EXL Health works with hundreds of organizations across the healthcare ecosystem.