How L.A. Care Health Plan Cleaned Up the Data-Quality Problems in Its Provider Directory

Rick Bemis, Senior Director, Office of Technology of L.A. Care Health Plan, knows the challenges and costs that can arise from incorrect data. Just eight months ago, the organization was faced with addressing corrective action plans (CAPs) from the State of California. Provider data that was submitted into the provider directory wasn’t meeting state quality requirements.

“Our data was very poor, and those corrective action plans were mounting all the way from 2014. We were facing mounting fees, and we really wanted to get to the corrective plans,” said Bemis.

In addition to wanting to address the corrective action plans, the organization also wanted to increase the quality of the provider directory to improve the lives of its members. With the old provider directory, a parent with three children might have each child assigned to a different provider in a different location. As a result, members could end up spending more time and money getting healthcare for their children.

L.A. Care Health Plan saw the opportunity to solve that problem with improved data quality as well. With a higher-quality provider directory, members can receive more value and a more efficient approach to obtaining healthcare. For example, the parent with three children should be able to get their children’s healthcare needs met in one single location.

To improve member service and address corrective action plans at the same time, the organization turned to MarkLogic.

Early Successes

Less than a year into its adoption of MarkLogic’s Operational Data Hub, L.A. Care Health Plan has already had some amazing early successes. Data ingestion speed and quality became much more efficient from the outset, eliminating complex and slow ETL processes.

How efficient was data ingestion with MarkLogic® compared to what they were doing before? “10 to 1. We were moving so fast that if we’d have had to do these ETL processes, we’d have never made our dates [for addressing our corrective action plans]. Because we found these efficiencies with MarkLogic, we were able to catch up,” said Bemis.

Improving the speed and efficiency of data ingestion also had a wide-ranging impact on the organization. Government processes don’t often move quickly, and because L.A. Care Health Plan works with the state government, its own culture had adopted a slow pace as well. After adopting the Operational Data Hub, it’s not just data that’s moving more quickly, it’s the organization itself. “The organization is on board, business users are on board and adoption is growing,” said Bemis.

What’s Next

With early successes driving adoption, the organization is now able to move beyond catching up with corrective action plans and drive innovation. One initiative that’s in the works is a plan to make their provider directory available via the website.

Like many organizations today, L.A. Care Health Plan is moving to cloud and enabling mobility. The MarkLogic Operational Data Hub has helped deliver recent successes with those initiatives. With faster, more accurate data integration, the organization can spend less time on ETL processes and more time successfully executing those initiatives. Bemis said, “With cloud and mobile apps, we can credential a provider or assign a site review person really quickly. And you can do it while you’re on the subway going to work.”

Ensuring Accuracy of Quickly Changing Information

Healthcare provider information changes frequently. In fact, up to 30% of data in the provider directory may change in a year, or about 3% a month. So, keeping provider data accurate and always up-to-date is no small feat for organizations. MarkLogic Enterprise NoSQL helps make it easier for L.A. Care Health Plan.

MarkLogic helps the organization with two important quality metrics:

1. Format. The organization must ensure that provider profile data conforms to specific EDI formats, HP 137 and EDI 274. Each provider record must have exactly 160 attributes, or it doesn’t meet the specifications. Once a source of quality control problems, MarkLogic helps to efficiently enforce conformity to the specifications. The organization was able to get participating Independent Physicians Associations (IPAs) to start providing the right format every time. It can automatically reject submissions that don’t have the right format and create error reports.
2. Content. Once the organization was able to ensure that provider profile information met format specifications correctly every time, they took on the task of validating the content of their provider directory. With the help of MarkLogic, the organization was able to perform external validations on NPI taxonomy and State of California licensing information. A total of nine external validations are going into production to validate provider information.

Quality Begins With Data

The results have been remarkable. Using MarkLogic to help drive quality metrics, L.A. Care Health Plan is seeing improvements in quality across the entire provider directory. “We’re seeing that the confidence level on each record can be 95% if we do this right,” said Bemis. Reports and attestations from provider networks back it up. Where the quality of provider directory information was once questionable, each and every record within the organization’s provider directory now carries a very high degree of confidence, no matter how frequently provider information changes.

How did they get there? Bemis himself says it well by commenting, “Anybody involved in data, we all know that quality starts at the point of capture.” And it’s true. When you use tools like the Operational Data Hub to get your data correct from the outset, you can drive quality and efficiency throughout your organization—just as L.A. Care Health Plan did.

Learn More

Learn how MarkLogic’s database platform enables digital transformation in healthcare and pharmaceuticals:

• See the interactive story, Escape the Matrix and its companion eBook.
• Read our ebook: Introducing the Operational Data Hub.