Posted by Kelly Sauders, Partner, Deloitte & Touche LLP
A growing number of retailers are actively expanding their businesses to include pharmacies and other health and wellness services. These organizations, whether they realize it or not, are essentially becoming health care companies. As such, they need to look beyond their traditional retail practices and begin to adopt leading practices and technologies from the health care sector.
Data analysis is an especially promising area. Many of the retailers we have spoken with have expressed more than a little frustration about the complexity and opacity of the health care system — particularly the payment process — and lamented the lack of available information and insight to help them streamline their operations and make smarter business decisions. Yet, in most cases the insights they are looking for are already at their fingertips; they just need the right analytical tools and techniques to unlock those insights from their existing data.
For example, data mining targeted at payment data can provide deep insights about why claims are being approved, reduced or rejected. This can help retailers boost their revenues and identify high impact improvement opportunities in their upstream operating processes, such as obtaining better documentation from health care providers to help ensure claims are not denied for lack of supporting data. Also, an in-depth analysis of payment data can help retailers identify and address critical regulatory and compliance risks — such as providing services that may not be medically necessary — before such issues can explode into headline-grabbing problems.
Over the years, retailers have finely honed their business processes for selling and delivering traditional goods and services. However, the unique requirements of the healthcare market are anything but business as usual. To operate effectively in this complex environment, retailers should try to learn whatever they can from companies that are already doing it — and then look for ways to use their own unique expertise and experience to do it even better.