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When it comes to understanding members and building trust, data plays a critical role, but a lot of times, working with member data can feel like putting together a jigsaw puzzle with missing pieces. At its best, member data can help providers understand a member’s needs and get a clearer picture of their overall health, but it can be challenging to find comprehensive and accurate data within a landscape riddled with “dirty data.” 

Here are three tips to help you navigate the landscape of member data:


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1: Consider the Source 

A lot of data within the healthcare system comes from claims that are submitted by insurance companies. Claims act as a snapshot in time, indicating the services or procedures a member received, as well as what drugs were administered. Other types of data might include member contact information, prescription claims from pharmacies, discharge data, and Electronic Medical Records. When looking at data, it’s important to consider where in the healthcare system it was generated, and the role it played at the time it was collected.

For example, Electronic Medical Records (EMRs) can offer a narrow but long view of a member’s health history from a provider perspective, whereas claims give a wide, but short view. Because members tend to see a provider over a longer period of time than they might stay on the same health plan, EMRs often cover a longer period of time than a member’s claim history, and will include more detail about the outcomes of their care. However, EMRs are often limited to a member’s engagement with a single provider, whereas a member’s claims history can offer a broader view into the types of care they received through their health care plan. 


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2: Look For Context 

When working with member data, context plays an important role in determining how reliable the data you’re working with is. On a medical claim, a diagnosis code might not be required in order for it to be processed, so it might be missing. With the data provided by the claim, it’s clear that a member was seen by a provider and received the services listed on the claim. However, without a diagnosis code, it’s impossible to know the underlying reason for the visit. In this situation, a member’s broader claims history can offer helpful data points about their health care needs throughout their enrollment in a specific plan, indicating treatments and frequency of visits. It’s important to recognize, however, that the most vital information is shared by the members themselves. 


Cartoonish, 3D rendering of two hand placing puzzle pieces into a loosely fitting puzzle.


3: Call In Experts 

When it comes to reaching members and engaging them effectively, data can make or break that relationship. On the most basic level, an out-of-date phone number can mean a missed outreach opportunity to someone receptive to additional support. In another context, inaccurate or incomplete information about a member’s health can pose a challenge to establishing trust, especially when working with communities that have been historically under-represented and under-served within healthcare systems. 

Reema can offer a comprehensive roadmap for understanding the landscape of member data to help build effective relationships with members that improve their health outcomes.

Whether you’re navigating questions around what types of member data can be shared safely and securely, or how to resolve discrepancies in member data, Reema has solutions that can help.

Our tech-enabled Community Guides are equipped with tools to better understand what members are experiencing so that this information is logged correctly in our system. We also work with health plans to understand how member data can be shared with us and can offer solutions for navigating backend systems as well as working with legal teams

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