Due to system and integration challenges, many IT executives and program managers working with healthcare and other social service benefits — 44% to be exact — are unable to use all available data, which costs health and human services agencies dearly and has resulted in an estimated $342 billion loss per year.
Those were the results of a survey of 155 IT executives and program managers done by MeriTalk, a public-private partnership focused on government IT, in conjunction with MarkLogic, a software company.
The survey found that when it comes to eligibility and verification of healthcare beneficiaries, managers said their number one challenge is data integration.
IT executives and program managers from health and human services agencies report a range of issues for which current systems do not allow them to do the following:
- Cross-check data with information stored in other departments (35%)
- Examine historical data (35%)
- Send data from the current system to a separate system (41%)
- Cross-check data with information stored at other agencies (44%)
- Run analysis to identify trends or anomalies (48%)
- Cross-check data with non-government information (63%)
Furthermore, just 22% of all managers said their current system is “analytical” and even fewer — 16% — said their current system is “intuitive.”
“There’s two things that jump out at me. First, as a former fraud prosecutor, this list of capabilities should be virtually required for any program moving billions of dollars,” Bill Fox, vice president of life sciences at MarkLogic, said. “Without it, there are cracks a mile wide for fraudsters to just walk through, siphoning off money that should be going to people that really do need it. Second is how high the ‘no or unsure’ numbers are. We’re not talking about being ‘almost there.’ These numbers are pretty close to 50/50. The fact that almost half the respondents say their systems lack these basic capabilities is an indication of [how] far the technology has fallen behind.”
These challenges lead to lack of timeliness and accuracy when it comes to delivering healthcare benefits as well as eligibility and verification issues, which the survey report said not only fails citizens but costs billions.