All of this is done to improve patient care—and help save lives. So why, when it comes to dealing with the integrity of the information that drives the pharmaceutical industry—the continuously changing drugs, eligibility, claims, and financial information that could cost their organizations millions and potentially affect quality of care—are pharmaceutical providers and insurers reluctant to take a lesson from operations in their own industry? According to a recent report on http://MSNBC.com/, one in five health insurance claims are wrongly handled. Avoiding such errors and inefficiencies could save up to $15.5 billion annually in administrative costs—money that could be used to improve patient care.
Unfortunately, healthcare insurers and pharmaceutical organizations continue to rely on costly, time-consuming manual controls and auditing processes. Failing to build automation into continuous monitoring of the business operations of healthcare is akin to throwing out all that expensive equipment in favor of the days when nurses took temperatures with mercury thermometers and captured the data on paper charts. The idea of monitoring a patient's health at long intervals and then analyzing it much later would be laughable to today's healthcare professionals. Yet, this post-event manual audit approach is accepted in many healthcare business operations.In today's atmosphere, when healthcare organizations—from delivery of care to delivery of payment—are being held to ever higher standards while being told they must do more with less, manual and internally built controls and monitoring solutions are no longer sufficient. They cost too much, require too many resources, and most of all, leave an organization too much at risk.
They can also interfere with the basic mission of any healthcare organization: affordable and high-quality patient care. Manual home-grown monitoring tends to focus more on the mechanics of control than on the health of the business and its ability to continue taking care of people and ensuring payment of their bills. And in an era when quality of care and ability to pay are national priorities, this orientation must change.
Continuous monitoring (CM) solutions that automate the verification and reconciliation of large, complex sets of information and provide real-time insight into exceptions or business rule violations are the best ways to cope with these risks. CM refers to the frequent, technology-enabled monitoring of key operational and financial information, processes, and systems in an organization. More frequent monitoring ensures that the business operations are performing as designed. Issues such as data errors, security violations, business policy violations, incorrect certifications and other violations are detected instantaneously. Management can rapidly respond with corrective action that prevents revenue loss, higher costs, and compliance violations.
CM enables drug manufacturers, pharmacies, and state administrations to continuously monitor and control all operational data and activities across an entire enterprise, providing more benefits than solutions focused merely on financial data or ERP systems alone. With CM, organizations can move beyond manual, semiautomatic, or even embedded controls, improving their ability to reduce costs, mitigate risks, improve business processes, streamline compliance, and ultimately save and improve lives.