From Siloes to Synergy: The Power of Data Hub

In this episode, we explore how data consolidation is reshaping health plan operations and why it is becoming essential for the future of the industry. From breaking down data silos to enabling real-time, data-driven decisions, data hubs offer health plans a scalable solution to improve efficiency and streamline processes. Discover the challenges health plans face today and how a data-centric ecosystem can unlock powerful insights, enhance member engagement, and drive cost savings. Curious how a data hub can revolutionize your operations? Tune in to find out how this technology is transforming the payer industry and why it's not just a trend but a must-have for success in 2025 and beyond.

Guest speaker

Host: Today, we're talking about something that’s not only been a hot topic in health plan operations but is also becoming an absolute must for success in the next era of healthcare — a connected ecosystem powered by a data hub.

Now, if you’re in the payer industry, you know that managing vast amounts of data across multiple technology platform siloes is a nightmare—no matter how much you try to organize processes, it’s messy if the data is scattered. But what if there was a way to streamline it all to connect the data and make it accessible? This would most certainly improve operations and give plans the ability to make data-driven decisions without inaccuracy or time lag. Well, that’s where our guest today comes in.

Joining me is Adam Fenech, Vice President of Product. He has been in healthcare leadership for over 20 years, on both the payer and provider sides of the business. Adam has a degree in Computer Information Systems and has deep expertise in core administrative products and processes, as well as the emerging industry shift to a data-centric, technology ecosystem model. Adam, thank you so much for being here today!

Guest: Thanks for having me! I'm excited to chat with you about how a connected ecosystem can really make a difference for health plans and why it’s so crucial for the future of the industry.

Host: Let’s start the conversation for anyone who might be new to the concept, can you give us a quick rundown on what exactly a connected ecosystem is and why it’s a game-changer for health plans?

Guest: Sure! So, at its core, a connected ecosystem is composed of an operational data store (ODS) and an integration layer that connects all the operational systems of a health plan to the ODS. We call it a data hub. Think of it like a repository for all the organization’s data. So, we’re talking about a bidirectional connection of all the internal systems like claims processing, member enrollment, billing, customer service interactions, quality, risk—all the operational technology a health plan uses is consolidated into the data hub. The data in the data hub is structured, which means it’s in a format that is usable on a day-to-day basis.  

Host: So, how is this different from a database?  

Guest: A database requires data to be predefined and structured for a specific end goal—it’s used for both long-term storage and daily operations. Except it requires highly skilled IT teams. A database requires hardware in large physical storage centers that require expensive upgrades. And most importantly, a database can’t connect disparate systems.

Whereas the data hub operates in the cloud with prebuilt integrations that pulls the data from all the different operating systems to eliminate silos. It also pushes the data back to the different systems so they are all operating from the same real-time, or near real-time data.  

Host: That makes sense. So, let’s talk about some of the challenges health plans are facing right now that a connected ecosystem could help solve. What are some of the biggest operational hurdles health plans are trying to overcome?

Guest: Well, one of the biggest issues is data fragmentation. Health plans often deal with multiple systems, each housing different pieces of critical data, and that leads to inefficiencies. For example, you might have claims data that lives in one system, member health data in another, and customer service interactions in yet another system. With all these silos, it’s hard to get a comprehensive view of your members or operations.

This fragmented data causes problems when it comes to decision-making, risk assessment, and customer service. You’re relying on outdated reports, and when you can’t access real-time data or near real-time, it can significantly slow down your response time to claims, member questions, or emerging health risks. And it strains strategic decision making.

Host: Can you make a cost justification for using a connected ecosystem?

Guest: Absolutely. A cloud-based data hub is much more affordable than legacy systems and physical database storage, which require costly system upgrades and ongoing infrastructure investments. Our data hub easily accommodates large, growing datasets and doesn’t require significant upfront infrastructure investments—plus you can scale up or down based on the business needs.

As far as operational savings go, having all of your data in one place enables faster claims processing, improves cash flow, expedites billing and payment reconciliation. It essentially enables faster operational processing, higher quality, and member engagement. The benefits are far-reaching across the organization.

You could also make the case that there are cost savings in early identification of fraud detection. With all of the operational data in one place, plans can identify inconsistencies or suspicious activities, such as billing fraud or abuse. Real-time access enables faster investigation and resolution of potential fraud cases. I would also consider accurate and timely reporting to CMS and avoidance of compliance penalties to be a cost saving.  

Host: So it’s not necessarily the operational data store itself that makes the ecosystem. It’s the prebuilt integrations between the operating systems to the ODS that maximize the data’s potential. Is that right?

Guest: That’s exactly right. The data connection between all operational systems informs the entire organization with one source of truth.  

Host: So, it sounds like a lot of the fundamental technologies needed to operate a health plan in 2025 and beyond are layered in—or around the data hub.  

Guest: Yes, we have many functional layers that stem from the data hub.  

For example, we can leverage the data hub for things like our self-service reporting platform for prebuilt metrics. This is a big deal for those who manage day-to-day core administration operations because they don’t have to rely on IT to structure the data and run reports; they can help themselves. With the data hub and the prebuilt dashboard working in tandem, managers can just log in to the dashboard and see the metrics that are relevant to them in whatever format they need—graphs, charts, whatever. For example, in a claims production report, you can see the total claims, new claims, adjusted claims, or a claims status report. You can see denied, consolidated, final, needs review, rejected, pending. You can see auto-adjudicated versus manual, EDI versus paper. This dashboard gets into the weeds and delivers managers what’s important for their day-to-day.

Other things we’ve leveraged the data hub for powering a workflow and productivity management tool for internal claims and enrollment teams. So, we’re using it to streamline internal operations for queuing and routing, audit management, SLA reporting. There’s also a HEDIS data engine, an automated, end-to-end enrollment and billing solution with prebuilt integrations to CMS for validations. Once you have the data store and the integration layer, the sky is the limit. If you think about the data store and integration layer as the sun, all the other operational components revolve around that.

Host: I can really visualize the ecosystem with that analogy. This sounds like something that would positively impact member engagement initiatives too.  

Guest: Yes. One of the many big wins of our data hub is that it enables a 360-degree view of the member—all their health data, claims history, and even their preferences. The data hub informs all the member channels, so no matter where the member turns within the health plan—from the member portal chatbot and mailers to the customer service reps—everyone is on the same page to support the member.  

Host: That sounds like a much-needed development in member experience.  

Guest: Yes, it’s something we’re very proud of.  

Host: Now, I imagine adopting this ecosystem approach isn’t as simple as just flipping a switch. What are some of the challenges health plans face when implementing?

Guest: Absolutely. As an example, we had a mid-sized health plan that was dealing with high operation costs, lack of centralized reporting, long call center wait times, and poor customer satisfaction scores. They were bogged down by multiple systems, none of which were communicating with each other. The health plan's employees were frustrated, and as you can imagine, the members were frustrated too, which was reflected in the plan’s quality scores.  

They decided to implement our ecosystem model, which we did in less than 12 months. That consists of a data hub, so all of the data is consolidated. Prebuilt integrations connect all the operational layers to the data hub, like the automated end-to-end enrollment, workflow streams for claims processing, the self-service dashboard for the plan managers who are making decisions about day-to-day operations, and the 360° member engagement technology. Within just the first year, they reduced overhead costs by an impressive 30%. They had a 90% reduction in monthly claims backlog, 50% reduction in call handling time, and a 25% increase in member growth.  

The transformation was amazing. It’s a perfect example of how consolidating data and connecting the technology ecosystem can transform operations and serve members with the healthcare they deserve.

Host: Wow. Thank you for sharing that—what a great reminder of why this work that we do with technology and the ecosystem is an essential part of making healthcare in the United States effective.  

Guest: Exactly. The future of health plan operations will rely on the ability to access and analyze data quickly and efficiently. And the data hub is really at the core of that.

Host: Adam, thank you so much for joining us today and sharing your insights. It’s clear that data-centric ecosystems are not just a nice-to-have but a must-have.

Guest: I couldn’t agree more. Thanks for having me on today.

Host: And thank you, listeners, for tuning in. If you liked this episode, share it with your colleagues on LinkedIn and visit our sponsor’s website at usthealthproof.com to find out how an ecosystem model is a must-have for the future of your health plan operations.