Leverage Data to Streamline Integrated Eligibility and Enable Health Insurance Exchanges
The demand for government assistance is at an all-time high. Health and human services organizations are facing unprecedented resource challenges, shrinking budgets, lagging technology, and aging populations. New legislative requirements are pushing organizations to find new solutions and innovative approaches, such as health insurance exchanges, to improve service delivery, focus on outcomes, and improve policy decision-making.
As organizations strive to implement a single, fully integrated case management system across multiple program areas, major obstacles remain to building systems to integrate organizations’ technology infrastructures. Poor data quality yields high error rates and predisposes organizations to waste, fraud, and abuse. At the same time, information residing in multiple systems across programs, agencies, and levels of government impedes the verification of eligibility. The impending deadline for states to deploy health insurance exchanges, as required by the Affordable Care Act, is driving many states to seek innovative and cost- effective solutions.
The Informatica Solution for Health and Human Services
Comprehensive, timely, and accurate data is imperative to determine benefits and calculate eligibility. The Informatica solution for health and human services streamlines health insurance exchanges by performing accurate eligibility determination and verification of evidence. It also provides a secure data infrastructure to safely store personally identifiable (PII) information and protected health information.
With this solution, you can:
- Save time by reducing errors, preventing overpayments, and properly handling change in circumstance calculations
- Increase efficiency through a holistic view of the client and program participation and access to large amounts of source data from numerous systems
- Boost productivity by empowering case workers and supervisors to access data themselves, freeing IT resources to focus on more complex data integration tasks
- Reduce compliance risk with ensured security and privacy of all personally identifiable information (PII) and protected health information (PHI)
Key Capabilities of the Informatica Solution for Health and Human Services
The Informatica solution for health and human services complements and extends the capabilities and performance of traditional and new integrated eligibility (IE) and health insurance exchanges (HIX) solutions. Unlike competing offerings, this solution enables access to data from new and legacy applications, transforms and combines disparate data for use by IE and applications for health insurance exchanges, and applies powerful data quality processes and logic to ensure that data is complete, accurate, and trustworthy.
Based on a single, comprehensive platform, the Informatica solution for health and human services features the following capabilities:
- Capture and linkage of all individual, family, and program data, regardless of its format or source
- Profiling of data, identification of data anomalies, creation and validation of data quality rules, reduction of data redundancy, and cleansing and standardizing of data before eligibility determination, greatly reducing error rates
- Centralized enforcement of security and compliance, insulating agencies from changes to applications and systems
- Creation, consumption, management, and monitoring of master data, enabling maintenance of accurate records
- Timely, comprehensive, and aggregated data across programs, improving decision making and outcomes
- Identity resolution from disparate systems, improving determination of benefits eligibility and reducing fraudulent claims
- Proactive alerting of potential fraudulent activity, duplicate payments, and other suspicious activity