Share |

Monday, October 6, 2014

3:15 p.m. - 3:45 p.m.
Track: Master Data Management: CDI View Track

CASE STUDY: RE-ENGINEERING MEMBER-PROVIDER RELATIONSHIPS IN HIGHLY REGULATED HEALTHCARE ENVIRONMENT

Wes Celestin, Enterprise Integration Manager, COMMONWEALTH CARE ALLIANCE
Jean-Michel Franco, Product Marketing Director, TALEND
Jaipal Kothakapu, President, ARTHA SOLUTIONS

Commonwealth Care Alliance is a not-for-profit, consumer-governed organization that provides a prepaid care delivery system for Medicare and Medicaid beneficiaries with complex medical needs.
It also provides enhanced primary care and care coordination through multi-disciplinary clinical teams including physicians, nurses, and behavioral health and geriatric specialists providing coverage from early intervention to urgent care to long-term services and support. The alliance also focuses on creating savings from reduced hospitalizations and institutional care. As the healthcare market place is undergoing rapid transformation, this nonprofit organization needed to embrace change as well in its core business processes. MDM, business process management (BPM) and a universal data integration platform were seen as key to the enablement of this next generation of processes. Specifically, CCA leveraged the data integration functionality of Talend to integrate member data for effective operational business processes including member management (care, drug and dental), billing and population health management. This session will illustrate how MDM can positively affect member:provider relationships by discussing topics such as:

  • Automating and governing member management via MDM to dramatically increase new member enrollment rate (from a few hundred per month to several thousands per month; a 20X increase due to ACA/Obamacare)
  • Mastering Provider information in MPI creation, maintenance and support via an effective cross-reference model for Provider management
  • Enabling the Data Steward platform via BPM and Web UI for business users to manage member data quality and Data Governance for downstream applications

>> Submit a question to this session's speakers

>> Return to Agenda