The Challenge

Pay-for-service models are in decline, and managed care, together with initiatives like the Affordable Care Act, has changed the healthcare landscape. Improved cooperation between payers and providers is needed not only to support the delivery of higher-quality healthcare but also to reduce costs. Such cooperation is hampered by the challenge of coordinating data from disparate providers and their often proprietary systems. Problems are exacerbated by the reality that providers’ first priority is patient care, not data validation. Payers can’t control which systems providers and patients use, so it is difficult for payers to assimilate clinical data or collaborate effectively with providers. Despite these challenges, claims data must be connected with clinical data and third party information to enhance care coordination and support new payment models in a time when the amount of healthcare data is growing exponentially.

5-0%

of individual contact information held by commercial healthcare payers is incorrect

8-0%

of medical records have erroneous information tied to an incorrect identity

15-0%

of individual contact information held by employers is incorrect

The Solution

Trillium’s data quality solutions help health plans develop a consistent, unified understanding of their members. With Trillium, you can consolidate disparate data from different systems to develop a single view of a health plan member. Among other benefits, Trillium helps:

  • Gain a comprehensive view of claims activity by matching data from many different provider systems
  • Improve claims processing efficiency by reducing the manual intervention needed to resolve minor identity anomalies between different payer/provider systems
  • Enhance member service interactions with accurate, up-to-date transaction records
  • Ensure an accurate data foundation for calculating various quality measures, such as HEDIS, CAHPS and Medicare Star ratings
  • Better manage fraud and other potential abuses by providing an accurate picture of claims activities specific to each member over time
  • Create a trusted data foundation for the analytics needed to ensure accurate underwriting and rate-setting processes

As Used By

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