The U.S. healthcare industry is experiencing unprecedented regulatory uncertainty, pace of change and pressure to evolve into a real-time, consumer-oriented, modern service industry.
The industry, like others before it, faces a steep climb in its digital transformation, conversion from B2B to B2C service model, and ability to leverage the increasing types and amounts of available information.
Most healthcare payers and providers are still dealing with data silos, standalone systems and applications, batch file processes and outdated infrastructure, such as mainframe and rigid, relational database technologies. Staying relevant and surviving the next three years is top of mind for most healthcare organization executives.
This past year, our company has engaged with more than 300 healthcare organizations regarding their priorities and plans for 2017. Based on that feedback, here are our predictions on the top five strategic data initiatives companies will prioritize in 2017.
Cybersecurity and compliance
A breach can put an organization out of business and change the competitive landscape overnight, putting whole identities, not just records, at risk. Yet, until the legacy infrastructure is modernized and streamlined, breaches will continue to increase and cybersecurity will be a topic of nearly every data-related discussion.
Non-compliance or a failed audit can also significantly impact enrollment and reimbursement. As companies migrate from home-grown to vendor solutions, whether on premise or in the cloud, they are dealing with a lack of system flexibility and a lack of experienced personnel to mitigate alerts. Compliance data hubs bridging internal data silos will emerge and create compliance 360-degree views and business intelligence scorecards with dynamic alerting to make compliance monitoring and audit readiness an ongoing, concurrent operational activity.
The hype around Hadoop is starting to fizzle as data lakes turn into data swamps with little to no data governance or successful use cases. Organizations are looking for enterprise data governance, provenance (lineage), security and privacy, and “refineries” to complement their Hadoop investments. More restore and rescue Hadoop projects will gain traction as cloud migration will be slow and filled with trial and error.
Combining structured and unstructured data – the NoSQL takeover
Decades of departmental development and purchasing of tools that rely on traditional relational databases have created data silos and have made enterprise-wide projects too cost- or resource-prohibitive. Companies will move their digital transformations forward — and create a full view of more personalized, contextual customer experiences — by using NoSQL technology to combine structured data and unstructured data that isn’t organized in a pre-defined manner.
As the benefits of a multi-model data platform become more pronounced, the shift to NoSQL databases will become clear. Breaking down barriers and related data silos using enterprise-grade data hubs is critical to driving innovation, achieving digital transformation and improving service, experience and workflow.
Metadata: The data about data
Metadata is the new oil in improving the consumer experience. The ability to quickly and efficiently look across multiple systems of record is key. With enterprise metadata catalogs and dictionaries, companies will improve the speed and quality of data searches and overall service. Improving experience, engagement, satisfaction and net promoter scores (NPS) are key drivers to Consumer360/Patient360 initiatives.
The industry will recognize the need for real-time clinical, administrative, financial and health device data to successfully support non-FFS payment models and risk sharing agreements. Organizations committed to the shift will begin to pay more attention to infrastructure technology, not just apps and workflows, and will invest in data platforms that will cross domains, not standalone applications or systems. As sustainability is a key focus area, there will be a push for member/patient “P&L” (profit/loss) views in real-time to optimize benefit designs and episodes of care.
Also on the radar
Organizations also provided other insights that will drive change during 2017. Although not ranked as high of a priority, change in the marketplace also will drive more merger and acquisition activity. Insurance and care delivery markets will tighten competitively, rewarding those with sustainable “two-sided” business models for Medicare, Medicare Advantage and Medicaid.
Limited “supply” or choice of federal exchange health plans, along with significant premium increases, in certain geographies will decrease perceived value of health insurance to on-exchange individual policyholders. Healthcare.gov will see neutral to increased enrollments and high consumer satisfaction scores for the online benefit enrollment experience.
Telehealth hype will cool overall, but major stakeholders will make significant strategic investments in nontraditional care settings, such as hospital at home.
Despite hype around machine learning and AI, we will not see scalable examples until very late in the year because of data pipeline and data quality issues.
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