Nicole Neumarker, executive vice president of development and innovation at Cotiviti, discusses the key areas to remember when developing new data models in health care.
Transcript:
What are some of the struggles with developing large data models for the health care industry?
Neumarker: So, in health care, data interoperability has been a focus and a massive investment over time. But I would say, seeing the yield of that is still a bit suspect at this point and when we look at what we're doing to lay down critical factors for successful data models, we think about 3 things. The first thing is how are we correlating and mastering our member or patient data? How do we make sure that when we get a massive amount of data about a patient, we're correlating the right information to the right patient and we're not double counting patients? That's a critical stage, which is mastering member data. The second thing is when you think about the longitudinal data of a member, it's really the temporality of data that you have to figure out how to structure appropriately so that you understand what's happening in time and the sequence of events that happen in health care. In your own life, you can recognize that a lot of things happen over time and there's gaps in that timeline and which gaps maybe have significant impact and which don't. So, understanding temporality of data is a second very important variable. And the third 1 is standard taxonomies and standard medical data that you want to bring into those data models. For example, having a very consistent set of provider data is critical, having the ability to bring in standard medical taxonomies, like HCC [hierarchical condition category] codes and other taxonomies that we use to understand the data behind the data, so to speak. You have to take those 3 things into account--mastering your member data, the temporality of member data, and then finally, standard ontologies, like provider or HCC codes. Those are 3 key areas we focus on for building out our data models.
Bridging Education Gaps in Treatment for Scarring Alopecia With Innovative Approaches
March 28th 2025Crystal Aguh, MD, FAAD, Johns Hopkins School of Medicine faculty, highlights the critical need for comprehensive education on hair loss across diverse hair types, stressing the importance of understanding inflammatory pathways for developing targeted therapies.
Read More
Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
Listen
Strategies for Improving Patient Access to Dermatology Care
March 22nd 2025Elizabeth Jones, MD, FAAD, highlights the persistent issue of insurance companies favoring expensive, newer medications over equally effective generics in dermatology, emphasizing the time-consuming prior authorization process and advocating for patient partnerships and systemic improvements.
Read More
Redefining Long COVID Care With Personalized Treatment
March 20th 2025To mark the 5-year anniversary of the COVID pandemic, The American Journal of Managed Care® spoke with Noah Greenspan, DPT, PT, CCS, EMT-B, cardiopulmonary physical therapist and director of the Pulmonary Wellness and Rehabilitation Center in New York City.
Read More