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Experian and NCPDP Launch New Patient Identifier

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By Keith Fisher, Senior Consultant

Correctly identifying patients for diagnosis, treatment and billing across the fragmented healthcare ecosystem is a challenging task. Currently, there is no uniform or universal way to do it. Recognizing the need, the industry has developed solutions with varying levels of sophistication and accuracy. [For a primer on why a national patient identifier (ID) is important and so difficult, see our article in the November issue of HIT Perspectives.]

A recent strategic alliance between Experian Health and the National Council for Prescription Drug Programs (NCPDP) is the latest entrant into the space. Their Universal Identity Manager (UIM) was launched at the November NCPDP workgroup meetings in Atlanta. The UIM is the process by which patient data is managed and a universal patient identifier (UPI) is assigned.

We all know NCPDP for its role in developing and maintaining standards for electronic prescribing and pharmacy transactions. Some of us may be familiar with Experian for its strong footprint in identity management for financial services. For example, it has created credit bureau matches for more than 220 million people. Come to find out, Experian also has long-standing and deep relationships in health care. According to the launch information, Experian has relationships with 880+ payers, 3,060 hospitals, more than 10,000 medical and ancillary groups representing over 350,000 providers across the United States. These relationships, matching methodologies and ability to handle numerous, varying data sources —coupled with NCPDP’s experience in pharmacy claims — make the UIM a possible game changer.

How it works. The vision is that organizations will send their patient-identifying information to Experian, where a universal patient identifier (UPI) can be assigned and duplicates identified. The UPI is then created (if there isn’t one already) by comparing the patient information submitted against Experian’s robust reference data on consumers. The UPI can be used in conjunction with an organization’s existing master patient index, as a complimentary solution. This can be done at various points in the patient encounter, such as when a prescription is generated or when claims are submitted or adjudicated. Ultimately, health plans can harvest the patient identifier from prescription benefits and marry it to medical benefits.

Experian’s UPI becomes helpful to an organization in two ways. First, it can help consolidate internal patient records, augmenting similar activities already in place within many organizations. Second, a UPI can be appended to outgoing transactions to facilitate the receiving entity’s location of the specific patient record at hand — even if different and multiple identifiers exist there on that system, so that when the results of such a query are returned to the originator, greater confidence may result in that the information is relevant to the intended patient.

This batch process depends on use of key data elements: name (full name, second surname and up to three aliases); address (Experian maintains up to 25 historical addresses); date of birth; and Social Security number, if available. This batch process will allow a UPI to be created and provided at no charge. Updated address or missing demographic information can be appended to the organization’s file for an additional fee.

Opportunities and challenges. Obviously, there are many opportunities and challenges associated with the launch of such an innovative solution.Three come to mind:

  • The business model is unclear. While a basic UPI will be generated for free, will that be forever or will there be a change later on? It’s a truism that there’s no such thing as a free lunch, so we wonder who ultimately will be paying for free UPI generation. The price structure for additional services has yet to be issued.
  • The UIM has implications for market positioning. Will the breadth and depth of this solution crowd out various offerings currently in the marketplace? Will it create competitive advantage for users? Will this create a solid basis for a national standard, should this become a reality in the next few years?
  • What about privacy and security? Experian maintains that safeguards and protocols are in place to handle billions of sensitive data records. Will the UIM be secure enough to satisfy the concerns of patient advocates, who killed the creation of a national patient identifier standard in the late 1990s? In these days of massive healthcare data breaches and identity theft, a system based on patient-specific identification numbers could raise alarm bells for advocates and legislators.

We wish Experian and NCPDP the best with the roll out of the UIM. We will be watching with interest to see how things unfold.

Keith Fisher

Keith Fisher

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