What Data Delays Are Costing Healthcare — And Its Patients

Healthcare organizations use data to guide care, manage benefits and understand how members use services. Yet most of healthcare still works with information that arrives too late to be useful. Claims take time to process, clinical information sits in separate systems, and vendors report on different schedules and in different formats.  

The outcome hurts everyone on the healthcare spectrum. Physicians provide incomplete recommendations, members miss care, health plans incur the cost of sicker members, and safety program funding is compromised by unchecked fraud, waste and abuse. 

When plans and their partners have real-time data — insights that arrive while a care team or plan support teams can still act on them — they can make better decisions to improve patient and member care while curbing unnecessary costs and financial leakage. 

This matters across healthcare, and it matters especially for Medicaid, Medicare Advantage, and dual-eligible special needs plans, where members often need close coordination across services and settings. CMS has recognized this and is beginning to address the challenge through its new ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) test model, which will pay technology-enabled chronic care organizations based on patient results instead of on a fee-for-service basis for original Medicare.

But even as the industry begins to prioritize stronger data to improve outcomes, sometimes healthcare organizations don’t have a practical understanding of where real-time data is possible, or haven’t made it a priority. As a result, they risk missing opportunities to create meaningful optimizations due to information-sharing delays. 

Why data sharing has been slow to improve

Healthcare has invested heavily in digital tools over the past decade, but data sharing has not kept pace. Health plans, providers, community organizations and service vendors often use different platforms and follow different reporting requirements. Even when teams collect information electronically, they still rely on manual uploads, data entry and labor-intensive follow-up to fix missing fields.

National data shows both the progress and the gap. The Office of the National Coordinator for Health IT (ONC) reported that 43% of U.S. hospitals routinely engaged in all four domains of interoperable exchange in 2023: sending, receiving, finding and integrating patient information. That’s up from 28% in 2018, but it still leaves most hospitals short of routine interoperability. For health plans and their members, that gap matters: Even among hospitals with access to clinical data from outside their organization, only 42% of clinicians routinely used it when treating patients. That means the information is accessible, but it’s not reaching the people who make care decisions. 

Non-emergency medical transportation (NEMT) offers one example of how these gaps play out for a specific health plan benefit. In many cases, plans receive reports well after the service date, which gives them only a limited view of who used the benefit, what service was provided and whether it complied with coverage rules. That delay makes it harder to understand member needs, improve delivery and identify unusual patterns early. Many other benefit areas face the same challenge.

Where timely data makes a practical difference

• Stronger oversight of fraud, waste, and abuse: When organizations review eligibility, service rules and utilization patterns closer to the point of service, they can spot issues earlier and manage benefits more consistently. For instance, real-time utilization data allows plans to confirm eligibility at the point of service, enforce service limits before a claim enters adjudication, and quickly surface unusual patterns, such as services billed for members who are deceased or out of state. The need remains significant: CMS estimated that there were $37.39 billion in improper payments in Medicaid in fiscal year 2025, along with $28.83 billion in Medicare fee-for-service and $23.67 billion in Medicare Advantage, with documentation gaps driving a large share of those errors. 
• Better visibility into gaps in patients’ care journey: People do not experience healthcare through claims files or reporting cycles. They experience it through appointments kept, services delivered and barriers removed. When plans and providers see missed services, scheduling issues or access problems earlier, care teams can coordinate support more effectively. A member who stops filling prescriptions, misses several appointments or stops using transportation benefits may be experiencing a health setback or a practical barrier that claims data alone will not capture. Research published in the American Journal of Public Health found that 5.8 million Americans delayed medical care in 2017 because they lacked transportation, with Medicaid enrollees facing significantly higher odds of that barrier. A meta-analysis of seven studies also found that providing nonemergency medical transportation reduced missed appointments by 37%. Transportation is not the whole story, but these findings show how practical barriers interrupt care when organizations lack timely operational insight. When plans see these patterns earlier, they can act while it still matters.
• More accurate benefit administration: Health plans design benefits with specific populations and use cases in mind, but getting the most from those benefits requires visibility into how members use them. Real-time eligibility and benefit validation, built into the scheduling or service delivery workflow rather than applied after the fact, helps ensure that services delivered match the coverage a member carries. That reduces incorrect billing, downstream claim denials and administrative rework. More current utilization data also informs benefit design decisions over time. In NEMT, for example, tracking whether members complete their trips rather than just whether rides were scheduled gives plans a more accurate view of whether the benefit delivers on its intended purpose.

Making better interoperability a priority 

Though we all know how important real-time data is, the ONC found fewer than half of hospitals achieve routine data exchange today, and even fewer clinicians consistently use outside data at the point of care. The good news is that technological infrastructure is making it easier to diminish the delays that are driving common care and operational gaps at both clinical and payer organizations. 

First, healthcare leaders must understand where lagging data is costing their organizations so they can help prioritize conversations with IT teams and vendor partners to close these gaps. As digital health investment and AI innovation continue to expand, understanding where and how data delays occur makes it much easier to apply real-time data to address these challenges, improving patient and member care, while simultaneously maximizing operations and financial performance.

Photo: Hiroshi Watanabe, Getty Images

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