Mission impossible: Understanding healthcare


Imagine that an employee in your organization transferred from one department or division to another. Say, Sarah in Finance took a job in Marketing.

Behind the scenes, a clerk in HR or a manager (via employee self-service) would process the transaction. Sarah would report to her new desk and manager without really missing a beat. Put differently, no one has to rekey in Sarah's entire vacation, benefits, job, and payroll histories. From a data perspective, her transfer is simply a matter of changing her current department from Finance to Marketing while allowing her history to be maintained.

Transactions like these are table stakes for enterprise resource planning systems—and have been for many years. Creating a duplicate employee record for Sarah is not only time-consuming; it will create all sorts of issues for her and her employer. Silly is the employee or organization that would ever contemplate such an ill-advised move.

Against this data-driven backdrop, one has to wonder what the wizards in many healthcare organizations are thinking—or whether they are thinking at all. As I discussed last year on CNBC, the industry is replete with waste and fraud, much of which stems from its often bewildering (mis)use of basic data. To make a long story short, the industry ostensibly ignores just about piece of advice given on this blog.

A Case in Point

My own carrier (XYZ) recently made a change in its plans, one that necessitated terminating the enrollments of each of its members. Rather than just add a new record to existing user accounts, XYZ management in its infinite wisdom required its members to reenroll. That is, they'd have to create new accounts, user names, passwords, and the like. Oh, and did I mention that the company didn't communicate this mildly important change particularly well to its customers and its employees? As a result, I spent more than an hour on the phone with both the dental and medical departments trying to iron out my coverage. (I pluralized departments because XYZ seems intent on maximizing the number of steps involved in determining your own coverage.)

When my philsimon login only manifested my prior benefits, I decided that it was time to show my screen to the unfortunate soul who happened to pick up the phone. (Thank you, Join.me.) Shana was perplexed; why was I only able to see my old enrollment information?

Knowing a thing or two about data, I suspected that I needed to reregister. After Shana gave me my new member ID number, I decided to give that a try.


Interestingly, I couldn't create an account with the name username of philsimon. Evidently, XYZ locked that field down, leading me to believe that these two systems—or, at the very least, tables—did in fact talk to each other. As a result, there are now two accounts in XYZ's internal systems on a single customer: me.

So much for a single version of the truth.

Simon Says

Want to manage your data well? You can start by doing the opposite manner of what most healthcare organizations do. To paraphrase Nicholson in As Good As It Gets, insurance carriers far too often seem to take away reason and accountability.


What say you?


About Author

Phil Simon

Author, Speaker, and Professor

Phil Simon is a keynote speaker and recognized technology expert. He is the award-winning author of eight management books, most recently Analytics: The Agile Way. His ninth will be Slack For Dummies (April, 2020, Wiley) He consults organizations on matters related to strategy, data, analytics, and technology. His contributions have appeared in The Harvard Business Review, CNN, Wired, The New York Times, and many other sites. He teaches information systems and analytics at Arizona State University's W. P. Carey School of Business.

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