How OvalEdge Enhanced Data Literacy for a Leading Medicare Contractor

OvalEdge helped a leading Medicare contractor overcome reporting challenges by implementing a robust data governance solution. This solution reduced technical debt, standardized data definitions, and improved operational efficiency. As a result, the organization now delivers faster, more accurate reports, supporting critical decision-making and paving the way for AI integration.

CLIENT’S PROFILE

The client is a Centers for Medicare & Medicaid Services (CMS) contractor, handling Medicare Part A and Part B claims for various U.S. regions. The organization provides support and guidance to healthcare providers and manages claims processing. It aims to maintain claims accuracy and compliance in Medicare administration.

CONTEXT

Since the organization is a Medicare & Medicaid contractor, it needs to furnish various ad-hoc data requests to Medicare monthly. To serve these ad-hoc requests, the organization faced challenges as different teams independently managed their reporting processes, leading to varying definitions for key metrics. Subject matter experts (SMEs) were frequently overwhelmed with requests to clarify definitions. This fragmented approach also meant retrieving crucial data fields from multiple sources, resulting in discrepancies and inefficiencies.

Additionally, knowledge within the organization was siloed, leading to duplicated efforts across analytics, dashboards, and communications, which drove up overhead costs and caused confusion, particularly for new employees. To address these issues, the organization sought a data governance solution.

WHY OVALEDGE

The organization sought a comprehensive solution capable of cataloging all its data sources and providing data lineage capabilities. Additionally, they were keen on partnering with a vendor with experience in handling healthcare data.

After inviting multiple vendors and conducting proofs of concept (POCs) for their data sources—including MicroStrategy, SQL Server, Power BI, and Informatica PowerCenter—they focused on ensuring the vendor could effectively create data lineage. OvalEdge was ultimately selected due to its responsiveness to the organization’s challenges and its ability to offer a strategic solution tailored to their needs.

SOLUTION

OvalEdge began by developing a comprehensive data catalog for the entire organization. This catalog created a clear inventory of all data assets, making data accessible and transparent across departments. Employees no longer needed to ask, "Do we have that data?" Instead, they could consult the catalog, gaining streamlined access to the company’s data ecosystem.

OvalEdge then implemented auto lineage across the organization’s technology stack. This auto lineage feature transformed how employees analyzed claims reports, allowing them to trace all analyses back to their sources. OvalEdge built the lineage for the organization’s complete technology stack, which included SQL Server, Informatica PowerCenter, Oracle, Power BI, and MicroStrategy.

With the data catalog and auto lineage established, OvalEdge deployed term analysis and impact analysis features to identify redundancies and inconsistencies in reports. This enabled the organization to trace reports to their origins, consolidate them to a single source, standardize calculations, and assign stewards for questions and clarifications.

OvalEdge's collaborative chat feature further facilitated communication among stakeholders, allowing report owners and consumers to collaborate effectively. This was particularly valuable in achieving consensus on standardized definitions for critical Key Performance Indicators (KPIs).

OUTCOMES

The implementation of OvalEdge's data governance solution resulted in a comprehensive business glossary with 100 KPIs and 1,900 critical data elements. Over time, this glossary became one of the most used resources within the organization. By providing standardized definitions, it reduced the learning curve for new starters and greatly improved data literacy across teams.

OvalEdge enabled the organization to curate 1,700 terms and 800 reports, making the entire data ecosystem transparent and easy to navigate. This increased data visibility helped streamline analytics and reporting processes, reducing operational clutter and redundancy.

Through term and impact analysis, the organization identified numerous redundant and underutilized reports, allowing it to prioritize essential ones and eliminate unnecessary items, which in turn reduced technical debt. Term analysis also facilitated the universal standardization of Critical Data Elements (CDEs) and KPIs, improving operational efficiency and cutting overhead costs by reducing duplication.

In summary, OvalEdge’s data governance solution enabled the organization to streamline its reporting process, reduce technical debt, and standardize data definitions. These improvements led to faster, more accurate government reporting, ensuring that critical decisions, such as drug pricing, were based on reliable data. The increased data visibility, quality, and accessibility also paved the way for future AI integration.