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Real-time data will transform compliance program effectiveness

Brenda H. Wade ( is Chief Compliance Officer and Tom Wagner ( is Director of Marketing at Inovaare Corporation in Cupertino, CA.

The hidden obstacle to achieving consistent compliance with Centers for Medicare & Medicaid Services (CMS) and state-level regulatory requirements—ever since the Social Security Act[1] gave the secretary authority to require Medicare and Medicaid entities to establish compliance programs in 2010—is getting access to real-time data. Unfortunately, most compliance teams still analyze and react to data through the rearview mirror.

Yes, nearly a decade of fines and penalties have motivated widespread adoption of board-level oversight regarding organizational risk and the implementation of enterprise-wide compliance programs. But the complexity of governance, risk, and compliance (GRC) processes makes maintaining an efficient compliance program a daunting task, especially when data reside across disconnected departments and databases.

The result? Compliance teams continuously chase data to catch up with the realities affecting their healthcare organizations today. Unfortunately, the reality of manually implemented compliance programs is that by the time a report is requested or an audit hits, compliance teams are already late.

Here’s the good news. Several medium and large health plans have implemented real-time compliance technologies that empower their compliance teams to move from being reactive data chasers to acting as proactive GRC process managers who add value to the bottom line by preventing noncompliance before it occurs. These forward-looking health plans transformed their compliance program effectiveness by leveraging big data to deliver continuously compliant results in relative real time.

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