Case Study: Total Health Care achieves real-time membership visibility, cleaner data and higher HEDIS scores with Precisely

Improving membership visibility, insights, and data quality

Total Health Care, a Michigan-based managed care organization serving about 100,000 members, faced fragmented membership processes across multiple systems and vendors that created duplicate records, poor visibility into membership analytics, and significant data-quality and financial risk. To address this, the plan selected Precisely to deliver an enterprise data-reconciliation solution to improve process visibility and membership data quality.

Precisely deployed a cloud-based automated reconciliation solution with real-time dashboards, daily 834 and monthly Medicaid-file matching, unique enterprise identifiers and a queued workflow for resolving suspect matches. The Precisely solution quickly uncovered update failures during testing, eliminated duplicate member records, improved HEDIS data quality and reimbursement, increased compliance and partner accountability, and delivered faster, auditable reconciliation and stronger membership analytics.

Total Health Care

Noah Monro

Chief Information Officer