The Truth About a Single Source of Truth

Years ago, when Medicare Part D was first introduced, a call center agent helped a senior member named Phyllis evaluate her prescription options. She was presented with a plan that would cost significantly less than what she was currently paying. There was a long pause. When Phyllis finally spoke, she was in tears. “I can’t believe it,” she said. “That’s so much less than what I’m paying today. I’ll finally be able to afford Christmas gifts for my grandchildren.”

Moments like this highlight why healthcare product leaders work tirelessly to get both the big and small details right. These real-life outcomes drive the mission of health plans to simplify and improve member experiences. However, the path to achieving these results is increasingly challenging.

Navigating a Complex Environment

Managing benefits, regulatory compliance, and consumer demand has grown more complicated. Product leaders face immense pressure to deliver innovative products while reducing administrative workload and costs. Regulatory changes, like the Affordable Care Act, the Transparency Act, and more recently, the Inflation Reduction Act, demand shifts in how health plans operate. In our recent webinar, healthcare experts Christina Moran and Jeff Yaniga, illustrated the impact of these changes.

• The Inflation Reduction Act: “How are health plans going to operationalize paying for prescription drugs over a period of months? And what does it mean for members when they arrive at the pharmacy and brand-name drugs are swapped for generics?”
• The Office of Civil Rights’ regulation for non-discrimination requires health plans to now provide documents in the top 15 languages per state (previously this was 15 languages across the nation). “How are health plans going to operationalize this change? How much earlier will they need to get the documents to the translator? More staff? More overtime?”

These questions underline the complexities product leaders face as they look forward to the next inflection point with limited operational capacity.

Finding a Path Forward: Operationalizing the “How”

Many health plans still rely on a fragmented approach using spreadsheets and manual processes. With varied versions of the same data, the risk of mistakes increases, impacting everything from claims processing to member communications.

“Even with a database, data often ends up in spreadsheet exports,” Christina explained. “This leads to versioning issues and gaps in accuracy, impacting member satisfaction and operational efficiency.”

The Transition to a Single Source of Truth

Scattered data leads to errors, inefficiencies, and compliance challenges. However, a single source of truth centralizes all plan data, ensuring accurate updates to documents, claims configurations, and member services information.

Christina emphasized, “A single source of truth enables us to set up rules, ranges, and indicators that prevent common mistakes. For example, setting limits on benefit levels ensures an extra zero doesn’t accidentally end up in a document or claims system.”

Why a Single Source of Truth Matters

Implementing a single source of truth offers several key benefits:

• Data Consistency: Working from the same, up-to-date data, ensures uniformity across departments.
• Reduced Errors: Automation minimizes manual errors.
• Increased Efficiency: Automated data exchanges save time, freeing product leaders to for strategic initiatives.
• Compliance Assurance: Accurate data ensures regulatory requirements are met efficiently.

The Road Ahead

Health plans today are expected to deliver more with fewer resources. Transitioning to a single source of truth isn’t just an operational upgrade—it’s a strategic imperative. Automating data exchanges and reducing manual processes allow health plans to reclaim valuable time, enhance member satisfaction, and navigate the complexities of an industry in flux.

Moments like the one Phyllis experienced remind us of what’s at stake. By embracing a single source of truth, health plans can build a solid foundation for both operational excellence and improved member outcomes.