by Angela Guess
A new article focuses on an increasing sense of urgency in the health care industry to improve information management: “With the Patient Protection and Affordable Care Act being implemented in stages through 2020, there has never been a more critical need for effective information governance at health care organizations in the United States. A powerful information governance program—one that sets forth clear structures, policies, processes and controls for managing data and information as business assets—offers significant benefits to health care organizations working to meet the new rules and requirements of health care reform.”
The article continues, “The absence of a strong information governance program can pose serious risks to a health care organization, particularly as provisions of the Patient Protection and Affordable Care Act take effect. Inconsistency in reporting and analytics can lead to noncompliance with reporting requirements of the Act. Noncompliance, in turn, could trigger substantial financial penalties for the organization.”
The article gives an example: “Recently, while assessing a health care payer’s analytical environment, our team discovered an anomaly that is all too familiar among payers: no one person or group at the client was solely responsible for compiling per member, per month numbers. In fact, various groups were using different definitions of PMPM and producing conflicting counts for analysis and reporting. As a consequence of a lack of governance over PMPM, the organization had inconsistencies across a number of reports and analytics. In the health care industry, PMPM is a hugely significant calculation—it affects 40 to 50 different analytical functions… Fortunately, at this organization, we were able to help them implement a program that addresses proper governance over PMPM calculations. The payer now relies on its actuary group alone to define PMPM for internal use and external reporting… But that’s just one organization. Too many others in the health care industry are needlessly at risk because they remain stalled in an early, fairly undeveloped stage of information governance and lack momentum toward a fully realized, mature and highly effective governance program.”
photo credit: jasleen_kaur
