CASE STUDY

Provider Data Mart

CLIENT’s Challenge

Our client, a non-profit managed care organization, was challenged by managing their data and reporting:

• Multiple data sources maintained by individual departments with no source of truth
• No integrated, enterprise view of provider data
• Inability to capture real-time changes to provider data

Failing a random federal regulatory audit spurred them to hire Impact Makers to help them create and implement a solution for their data.

OUR APPROACH

Impact Makers’ Data Analytics experts:

• Instantiated a Data Mart to serve as the first step toward a Single Source of Truth for data across all their providers
• Leveraged their deep understanding of healthcare industry tools and standards such as NPPES, Melissa data, and LexisNexis to validate provider information via automated APIs
• Defined and implemented data quality and enrichment rules around address standardization, specialty codes, and state/DEA assignments
• Developed a migration plan to sunset various department-specific data cubes and marts with the new enterprise provider mart
• Leveraged the new mart to centrally manage provider directories across the entire organization

skills & tech leveraged

Data Analytics, Data Engineering, Healthcare Provider Expertise, Regulatory Compliance

THE RESULTS

By utilizing Impact Makers' expertise, our client was able to realize:

• Maximized investment in reference data from LexisNexis and Melissa data
• Standardized provider data mart across four (4) Health plans and five (5) states, used to source both online and print versions of the Provider directory
• A 100% increase in auto-adjudication rates from 30% to 60%
• Reduced cost to produce online and print provider directories by 40%
• Increased member satisfaction and reduced provider abrasion