A Primer in Data Management for Healthcare Payers

by | Oct 17, 2022 | Healthcare

It’s important for healthcare payers to fully understand the challenges of data management.

You can’t ever get enough data. At least, not the kinds you need.

But once you have data, combing through digital haystacks to find relevant and useful pieces of data is not any easier.

Data management is no small task, so healthcare payers should take master data management seriously. This guide defines data management for healthcare payers and explains the “why?”, “who?”, “what?”, and “where?” of healthcare data management.

Key Takeaways:
  • Healthcare data is challenging in a few unique ways, such as additional privacy regulations.
  • Data can take many different shapes and forms with varying levels of complexity and difficulty.
  • Data management brings data from various sources together into one central repository.

Defining Healthcare Payer Data Management

As with other burgeoning technologies, data management isn’t always well understood. Data management goes a step beyond document management by compiling data from multiple sources across multiple organizations.

In the healthcare field, this means that data connects multiple healthcare providers to improve communication between colleagues and patients, but also to improve patient outcomes by using AI and data analytics to find trends in large repositories of data.


There was a time when data management was an ad hoc process: data was stored either on paper documents or in the minds of healthcare workers. Over time, this practice has grown more structured with procedures for documenting and sharing information.

In the digital age, this practice has taken a giant leap forward as healthcare providers can communicate data via networks, access information remotely, and large amounts of data can be stored and analyzed much quicker than paper documents.

There are two main reasons that healthcare data management is important:

  • Improved Communication. Well-managed healthcare data mitigates the human error that comes along with remembering and communicating data face-to-face. While humans make mistakes, data management creates a single source of truth that all the users of that data can access. A single source of truth must be reliable, accessible, and timely. Without data management procedures in place, coordinating data between individual users would be difficult, but coordinating data reliably between organizations would be nearly impossible.
  • Improved Outcomes. Ultimately, healthcare aims to pursue positive outcomes for every patient. Humans are good at recognizing patterns but bad at comprehending large amounts of data. What’s difficult for humans is easy for computers—software can analyze large collections of data to find trends that would be invisible to human eyes. Data management software helps healthcare providers create treatments and even diagnose patients, and data management facilitates these improved outcomes.


A single source of truth must be reliable, accessible, and timely.
Image Source: https://www.erp-information.com/single-source-of-truth


Healthcare data takes many shapes and forms, and many parties collect it. Healthcare data is unique from other industries for several reasons.

The nature of the information included in healthcare data makes consumer protection especially important. The Health Insurance Portability and Accountability Act (HIPAA) creates guidelines for what kinds of healthcare information parties can communicate and to whom. The intent of HIPAA is to protect consumers against discrimination, and generally, HIPAA states that healthcare providers must not disclose protected medical information to anyone other than the patient themselves.

However, not all kinds of healthcare data are subject to HIPAA rules. Personally-identifiable information (PII), including Protected Health Information (PHI), is protected under HIPAA because it can be used to identify the individual they correspond to, but HIPAA does not restrict de-identified data such as aggregate information.

In short: healthcare data is more complicated than data in other industries because of the additional regulation surrounding Protected Health Information, so it’s important to carefully consider who has access to what pieces of data. While aggregate data may be appropriate for a wider audience, protected health information is available to only those who have an immediate medical need, such as the patient or their physician.


Healthcare data encompasses a broad scope of information ranging from prescription records to demographic information to test results.

Generally, there are six main categories of clinical data that healthcare providers could use:

  • Electronic Health Records or Electronic Medical Records (EMR) are primarily gathered at the point of care (clinics, hospitals, etc.) and include insurance information, diagnoses, treatment plans, etc. Internal staff generally use this data, and healthcare providers don’t typically provide it to external researchers, although there may be exceptions.
  • Administrative Data includes discharge data collected by hospitals. Hospitals report administrative data to government agencies such as the Agency for Healthcare Research and Quality (AHRQ).
  • Claims Data is especially relevant to healthcare payers as this is the data pertaining to billable interactions between patients and providers. Claims data includes four sub-categories: inpatient, outpatient, pharmacy, and enrollment data.
  • Patient/Disease Registries contain data about certain chronic conditions ranging from heart disease to Alzheimer’s. Healthcare providers use these registries to research and treat specific conditions, and the information is available to any organization participating in the registry.
  • Health Surveys are much more widely accessible than other types of healthcare data. The results of health surveys may be available to the general public and exist primarily for research and awareness.
  • Clinical Trials Data is more specific than health survey data but is accessible to a narrower range of researchers.


An example of a digital health survey.
Image Source: https://www.123formbuilder.com/free-form-templates/Health-Assessment-Questionnaire-1932213/


A key feature of data management is that it accepts inputs from multiple data sources, combining them into a single source of truth. There are four main sources of data that healthcare payers coordinate data from:

  • Administrative Data. As discussed in the “What?” section, hospitals collect Administrative Data and report it to government agencies. Administrative data will include the type of service, location, and amount billed. This data won’t include the full clinical information that a patient’s medical records would contain, but Administrative Data is a valuable source of insights despite this limited clinical information.
  • Patient Medical Records. Patient medical records are the most complete and extensive source of clinical information. However, this data is expensive for two reasons: because the data is expensive to obtain and because the data is expensive to process.
  • Patient Surveys. Patient surveys collect information directly from patients. This data is valuable because it comes directly from the source and because patient surveys are easily digestible by consumers, but it is less detailed and specific than clinical data.
  • Standardized Clinical Data. Certain healthcare providers, such as nursing homes, collect standardized clinical data. This information is useful because it is—as the name suggests—in a standardized format, but that same standardization limits the scope of the data.


Are you interested in taking your data management to the next level but unsure where to start?

Coperor is a data management solution from Gaine that is tailored specifically for the healthcare industry.

Managing data isn’t an optional activity for healthcare payers. It’s essential. You shouldn’t leave your healthcare data up to chance. Trust the experts at Gaine to help you make the most of your valuable data.

If you’re ready to take the next step, contact us today to learn how Gaine can help.


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