Inaccurate Member Data Can Be Inefficient, Expensive and Potentially Dangerous

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Member Data HealthcarePlan members move, change their names and sometimes use a middle name or initial – and sometimes they don’t. Members also change employers, and sometimes move between Commercial, Medicare and Medicaid coverage types, all with your plan. This can make it challenging for payers to accurately identify and provide continuous, personalized service to each of their members.

This endless pursuit of correct member data is not just time-consuming – it can be lifesaving, ensuring the right member gets the right information and call to action for their specific health condition can impact a member’s overall health outcomes for years. Beyond member health and engagement, there are member retention and privacy issues. For example, send the wrong member details of someone else’s medical record, and it’s possible you’ve violated HIPAA privacy regulations in multiple ways.

Whether you call it ‘data accuracy,’ ‘data hygiene’ or ‘data integrity’ –organizations have a massive task to manage member demographic information that can change and erode quickly. In fact, organizations believe poor data quality to be responsible for an average of $15 million per year in losses. 2

If you struggle with data capture, data integrity and record maintenance, you’re not alone. These issues continue to be challenges for the healthcare industry. Members who seek both virtual and in-person care can inadvertently create duplicate profiles, and a typo or transposed digits can make some systems identify one member as two. Adding to the challenge, 27 million Americans move
every year,3 50,000 name changes are requested each year,4 and an estimated 21 million annual employment changes are reported.5

Inaccurate data also costs payers in claim delays and rejections, returned mail processing expenses, increased operating costs when members cannot use digital channels, wasted time calling incorrect phone numbers and manual efforts by employees to fix the discrepancies. Member satisfaction can be impacted when wrong or duplicate information causes breakdowns in communication and inconsistent service experiences across different parts of your organization. Furthermore, even small inaccuracies in one data source can get amplified when multiple data streams get combined or in downstream data transformations, causing a host of inefficiencies and creating risk for privacy violations.

Potential Solutions

How to stay ahead of these daunting data tasks? Consider a data partner that can effectively verify individual identities by combining information from multiple databases. Merging these sources seamlessly is important because precision health leverages information from various sources, including lifestyle, environment, social media, medical records and medical insurance claims to enable
personalized service, help members manage health conditions and prevent illness, and reduce risk of privacy breaches.”1

The more information sources a data partner uses, the more accurate the results likely are. You’ll
want  a data partner that has a large database covering the vast majority of adults , but quantity isn’t all that matters. Pick a data partner that has advanced linking technology to optimize accuracy from thousands of disparate data sources. 

Another way to advance data accuracy and privacy is to assign a unique identifier, one not tied to a social security number, to each member. Proper identity matching can help ensure the correct member receives the appropriate services from your plan.

A unique identifier acts as the linking agent for all data points associated with a specific individual, allowing payers to match and merge the same identity into one record. Also, enriched data can help add any missing data elements to your contact information so that surveys are consistently delivered to members to improve quality ratings, to help streamline and automate outreach, and to optimize member engagement and retention. 

Potential Results

Inaccurate demographic data can negatively impact your business. Ultimately, you’re tasked with delivering a great member experience and coordinating the best care possible. When choosing a data solution, you need to make a good choice that gives results. Results can vary among healthcare organizations but what kind of results can you expect from a data cleansing and enriching solution?

In a specific case study, a Medicaid health plan was experiencing issues with their data integrity. After using our member demographic data cleansing and enrichment solution, improved the contact rate by 43% in the first month which doubled compared to the previous year. This helped the health plan communicate benefits more effectively, helping members get healthy and stay healthy.

Ensuring data integrity is essential to maximize efficiency, minimize unnecessary expenses and potentially risky mistakes associated with incorrectly contacting individual members. We offer solutions that can help payers avoid the frustration and worry associated with managing and protecting member data quality on their own. 

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3. Moving Statistics: Industry Trends & Data (2023) (

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