The Impact of Big Data in Healthcare?

One of the newest and most commonly blogged about buzzwords in the healthcare industry is big data. What is big data in healthcare? As defined by Wikipedia big data is an all-encompassing term for any collection of data sets so large and complex that it becomes difficult to process using on-hand data management tools or traditional data processing applications.

Big data in healthcare includes electronic patient records, billing, reimbursement levels, procedure documents and so much more. With this information collected and stored in larger accessible databases the industry as a whole is able to stream line their processes and start delivering more effective results.

Recently, or in the past 5 years, your medical providers may have alerted you to the fact that they were switching over to electronic files – rather than having the paper files stored in their office.  At first there were a lot of complications with this, which you may have experienced firsthand. It was very easy to type in something incorrectly or misplace a file- this not only being inconvenient for you but essentially (unless you had backup copies) it displaced years of patient history. This history is what allows doctors, physicians, surgeons, to create a better method of treating you, or tells them what they can improve on in a surgery. In other words this history is crucial to the progression of the healthcare industry.

So, how does any of this apply to Consilium? Earlier in the blog I mentioned reimbursement levels and billing. Every time you go to the doctor you are billed a certain amount for a particular service, all of these are compiled into databases and we refer to this as UCR (Usual, Customary, and Reasonable) Data.  UCR data according to Healthcare.gov is the amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.  When you are covered under Medicare, there are established rates that Medicare would allow – also known as Medicare Allowable. Providers who participate with Medicare agree to accept the Medicare allowable charge as full payment. There are some Providers who may participate with Medicare but still bill above the allowable amount.

This is where Consilium comes in.

The Consilium Team uses the UCR data, the Medicare allowable – this big data- to help them negotiate a claim. They look through and see what the provider has previously billed for a certain line item, they see what Medicare would reimburse and start their negotiations based off of this data. Big Data is an extremely large part of what makes Consilium successful, and what continues to help us grow and progress as the industry progresses.

Everyday Consilium is adding more data and constantly evolving into something bigger and better. Big data is crucial to the evolution of Consilium & the healthcare industry.