Provider Sponsored Plans (PSP’s) have unique data sharing needs requiring complete transparency on some items to allow for seamless patient care and complete segregation of others for protections of patient rights’ and legal compliance.

The Venn diagram shows the simplicity of the need, but the issue comes when the lines have to be drawn in data that is commingled throughout various systems.

• Provider Only Data can include self-pay visits and some visits for patients that are not associated with the plan.
• Plan Only Data can include information for members who do not have a relationship with the provider owner or claims covered under a Third Party Administer (TPA) arrangement.
• Shared data includes code sets and other lists of values that don’t inherently provide information on their own.

The drawing is simple, but the implementation can be complex. Wyntec has the services necessary to ensure that all of the data and rules required are implemented seamlessly throughout the organization.

Data models are readily available

• The Wyntec data models are multi-source and mastered so that your data can all live in the same domain, but maintain its lineage and source information.
• The models contemplate both plan and provider differences in how attributions are applied to individuals.
• Whether you share a single operating system or have multiple systems that need to be combined, the models accommodate your complex legal and business make-up.

Rules Based Engine controls who sees what

• The power of the security comes from the rules based engine that will apply necessary rules to the data sets before serving it through to data customers across the enterprise.
• You can define as many populations as you need to manage your business and your data. The rules are then run against the data to ensure that only the data fitting the population are released. These rules can be based on any data at any layer of the organization, unlike some rules that come pre-defined from operational systems. For example:
  • Exclude any patient that has had an HIV diagnosis from the data set.
  • Exclude any claim for a member that was covered by a TPA arrangement.
  • Exclude any visits and associated diagnoses, labs, orders, from a patient who is self-paying for the visit.
  • Exclude any patients that have not had a claim with the provider in the last 5 years.

If you can define the rule, the engine can apply it.

Wyntec has the experience and tools you need to successfully navigate the data complexities of your multifaceted organization.

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