Achieving Data Excellence
Start Your Journey to
Becoming an EDI Champion.
Divers, gymnasts, cyclists, hurdlers, basketball teams, and sprinters train relentlessly and strive for excellence to reach the podium.
Similarly, EDI leaders must ensure accuracy, innovate continuously, harness data effectively, surmount daily and strategic challenges, foster a culture of teamwork, and celebrate successes along the way.
For health plans, the results from these collective efforts include significantly reduced costs, enhanced claim processes, and improved member satisfaction. Keep reading to see how you can incorporate the best practices of the world’s greatest athletes to achieve data excellence and join the pantheon of EDI champions.
The Pursuit of Perfect Precision
Divers utilize a set of techniques to hit the water with perfect precision, make a minimal splash, earn high scores, and win a medal.
Similarly, EDI managers reach high levels of accurate EDI claim management by incorporating automation and moving away from costly, manual processes and paper claims. Achieving excellence in claim management stems primarily from closing the proximity of error, adopting a fully-automated claim process and increasing auto-adjudication rates. This requires meticulous attention to detail, while precisely configuring systems and settings. Achieving auto-adjudication rates of 85% or higher, moving away from paper claims and manual processes, and validating claims will enhance accuracy, drive cost savings, and improve staff bandwidth.
Adaptation and Innovation
In the high-stakes world of gymnastics, adaptation and innovation are key to a gold medal performance. Olympic gymnasts must adapt every motion to maintain speed, contort their bodies for full rotation, and land in-bounds perfectly.
In the ever-changing healthcare industry, staying competitive requires EDI managers to stand at the forefront of technological advancements, like adopting cloud-based EDI solutions or integrating Fast Healthcare Interoperability Resources (FHIR). These innovations are revolutionizing claim management in ways that will enable enhanced data accuracy and ensure compliance with ever-changing regulations. EDI managers must not only be aware of advancements, but stay at the forefront of technological progress.
Harnessing the Power of Data
Data is the driving force behind both cyclists and EDI managers. For athletes, performance measurement, from power output to watt-to-weight ratio, are crucial for success.
In healthcare, harnessing the power of data can transform operations. Through analytics, EDI managers can gain valuable insights into claim trends, like identifying high-utilizers who drive up costs and loss ratios, detecting fraud, and optimizing payouts, and more. This proactive approach – rooted in data analysis – can lead to reduced costs, more precise payments, improved security, and enhanced efficiency across the business. All of this can ensure a smoother path to claiming the gold standard in healthcare EDI management and data exchange.
Overcoming Hurdles
Olympic hurdlers prepare extensively to strike an ideal balance between power and mobility in order to leap over ten hurdles, each approx. 42″ in height, all in just about 15 seconds.
EDI managers must consistently prep for the challenges impeding daily and long-term strategic goals. This includes maintaining secure networks, reducing manual errors, dealing with compliance changes, and more. Overcoming these obstacles requires thoughtful preparation, strategic problem-solving, and implementing your plan when the time comes. The difference between winning and losing in data excellence can come down to the inability to prepare and execute – just like world-class hurdlers.
The Role of Teamwork
Every gold medal basketball team tapped into the unmatched potential of teamwork to succeed. This includes the players, as well as the dedicated group of coaches, trainers, and support staff.
In healthcare data management, teamwork is equally vital. Collaboration between EDI managers, IT and operations teams, and technology partners is essential for achieving peak performance. This collaborative effort results in seamless workflows, enhanced automation, reduced manual labor, and better cost management. By fostering a culture of open communication and cross-functional cooperation, organizations can ensure that every team member and partner is aligned with the common goal of excellence in data management.
Celebrating Achievements
Every milestone reached on the track, whether it’s a personal best or a new world record, is a cause for celebration.
In healthcare claim management, it’s important to celebrate achievements, like resolving complex claim issues or achieving an all-time high auto-adjudication rate. Celebrating small and big wins “stimulates dopamine release in the brain, a feel-good chemical that reinforces the learning experience and strengthens our sense of connection to those we work with.” (per Harvard Business Review, “Celebrate to Win,” 2022) Celebrating these successes not only boosts morale, but also reinforces the commitment to continuous improvement and excellence.