Root Cause Data Integrity Issues Impact Quality

Data Integrity | Mile High Healthcare Analytics

Mile High Healthcare Analytics understands that data integrity is critical to risk adjustment and quality improvement success. In fact, data quality management is the starting point for nearly every client engagement. When it comes to quality improvement initiatives, data governance needs to be done at the individual member level and organizations must address the most common root causes of data inaccuracy. In large organizations where data is funneled from a variety of sources, it isn’t always clear who owns data governance and clean-up. A detailed evaluation of the end-to-end data management process is a helpful way to uncover issues that hinder an organization’s ability to correctly understand and address data gaps.

Common Data Quality Gaps

High Healthcare Analytics recently conducted an end-to-end analysis for a Fortune 50 Health Plan with a focus on data integrity for quality measurement. The analysis revealed a number of important gaps that are common to many organizations and can addressed with an improved process flow. Some of the key findings included:

  • Year over year comparisons failed to take into account changes in NCQA specifications
  • All data focused on Medicare-Advantage star ratings, needed to include commercial QRS population
  • Member-level/service-level data files lacked quality control – obvious gaps surfaced by quick manual review
  • Pharmacy claims files had incomplete NDC codes, contained obsolete national drug codes
  • Clinical laboratory files missing LOINC codes
  • Incomplete data on utilization
  • Member/Provider identifier inaccuracies

For this large health plan, the lack of accurate data on their quality drivers, made it virtually impossible to create an actionable quality improvement plan.

Value of a Neutral, Experience Third Party

In-house resources often lack both the time and expertise to complete a thorough root cause analysis. Plus, internal silos make it difficult for any single department to have complete visibility. To uncover systemic data integrity issues, Mile High Healthcare Analytics interviews all internal and external stakeholders, and evaluates the data flow process from end-to-end. The plan’s Senior Finance Director articulated the advantages of bringing in focused experts;

“For any large plan needing to conduct a deep dive analysis on quality, I highly recommend they consider hiring a neutral third party with experience in health plan data quality and risk adjustment. The insights Mile High Healthcare Analytics brought to our project have resulted in immediate improvements in data integrity…our whole team was impressed with their understanding of the business and ability to propose practical improvements.”

Developing Actionable Scorecards

Without good data, it is impossible to create a quality improvement plan with confidence. The Mile High team is able to create simulations that help clients zero in on those metrics that will make the biggest impact on overall quality scores. With a data-driven quality plan, clients can create dynamic scorecards that pinpoint the top metrics they need to manage at the plan, provider and individual physician levels.

How confident are you in your quality improvement plan? If the underlying data is flawed, your ability to reach your quality improvement goals could be in jeopardy. For an end-to-end data integrity assessment and action plan, call the experts at Mile High Healthcare Analytics. To schedule a consultation, call 720-446-7785 or email