The importance of accurate member identity in the performance of payer organizations

Abstract

Objective: To describe perceptions among healthcare payers of the importance of and challenges in ensuring accurate member identity in payer organizational operational performance.
Methods: A survey of 35 US healthcare payer executives evaluated perceptions of the importance of accurate member identity to efficient operations and achieving payer strategic priorities, improved financial performance and member satisfaction, and the associated challenges.
Results: Healthcare payers were highly aware that accuracy of member identity is essential to operational effectiveness and efficiency (90.0%). Leading organizational challenges were managing high risk members (43.3%) and effective member engagement (40.0%), both impacted by member misidentification. A majority (73.3%) indicated that current system capabilities do not enable the capture and sharing of accurate, complete member identity, with 43.0% stating it was extremely/somewhat difficult to add member data sources and remove member record duplicates. Only 10.0% were moderately or highly satisfied with the accuracy of their existing member identity management solutions.
Conclusions: Inability to know “who is who” is perceived by payer organizations as impeding financial performance and growth, operational efficiency, and member engagement/satisfaction. While recognizing that member identity impacts nearly every aspect of payer operations, most payer executives lacked confidence in their organization’s ability and deployed technology to achieve a complete and accurate 360-degree view of members.

Keywords

Patient identity / Patient misidentification / Member identity / Identity accuracy / Digital transformation / Healthcare strategic priorities / Payers / Health plans

ACKNOWLEDGEMENTS

The authors are grateful to the individuals who responded to the survey and conveyed the information comprising this report.

AUTHORS CONTRIBUTIONS

Dr. Gellert wrote the article, interpreted the data, compiled the tables and figures, and completed the literature review. Mr. Erwich contributed to the design of the survey, and was responsible for implementation of the survey. Ms. Krivicky- Herdman assisted with survey development and implementation, as well as the data analysis. All authors read and approved the final manuscript.

FUNDING

This study did not have any grant or other external funding.

CONFLICTS OF INTEREST DISCLOSURE

MEE and SKH work for a health information technology service provider that focuses on improving the accuracy of patient identity by leveraging a proprietary referential database software solution set. GAG is an external medical advisor to the same service provider.

ETHICS APPROVAL

The Publication Ethics Committee of the Sciedu Press. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

PROVENANCE AND PEER REVIEW

Not commissioned; externally double-blind peer reviewed.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

DATA SHARING STATEMENT

No additional data are available.

OPEN ACCESS

This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).

COPYRIGHTS

Copyright for this article is retained by the author(s), with first publication rights granted to the journal.

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