Addressing Root Cause Data Integrity Issues

Mile High Healthcare Consulting 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.

Identifying Common Data Quality Gaps

When it comes to risk adjustment and quality improvement program success, data governance is critical.  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. To uncover systemic data integrity issues, Mile High Healthcare Consulting interviews all internal and external stakeholders, and evaluates the data flow process from end-to-end. Mile High frequently performs data audits for clients to uncover gaps that can negatively impact program effectiveness.  Some examples common gaps we uncover include:

  • Incomplete data on utilization
  • Lack of quality control on member and service-level data files
  • Missing LOINC codes
  • Member/Provider identifier inaccuracies
  • Pharmacy claims files contain incomplete or obsolete NDC codes
  • Year over year comparisons failed to take into account changes in NCQA specifications

Using large and complex datasets of patient-level data from claims, pharmacy, clinical laboratory results, members, government-supplied data files, and supplemental data, we roll up our sleeves to clean and then analyze the data.

Integrated Data Warehouse

Most organizations manage risk adjustment and quality data in silos making it difficult for any single department to have complete visibility. We have developed an integrated data warehouse that can drive your quality, risk adjustment, targeting and ROI initiatives from one place. And, it can run data from all lines of business. This flexibility is built upon a solid foundation, a comprehensive data logic and physician data model, driven by rules based ETL and edits that ensure high quality, and consistent data availability for any of our subsequent applications.

Developing an Data Governance Platform

Mile High focus on data quality is extremely intense during the first two months of each client engagement.  We work diligently to confirm data feeds, fill gaps and and map to the myriad of warehouse tables. Once we taken the time to rebuild your data warehouse, your ability to move your organization forward on multiple fronts is just a reload away. Let our team examine your data structure and demonstrate how fully knowing and understanding your information can propel you ahead of the competition.