5 Ways Health Plans Can Leverage Big Data

Apr 17, 2018

Health plans, don’t let your data go to waste

In healthcare, disruptive innovation lately centers around the Big Data Revolution. And for many established health payers and plans, talk of overhaul can seem overwhelming. Changes trickling in over the last several years haven’t always been as easy to implement as they sound on paper.

If all the talk surrounding data and disruption has your health plan concerned, it may be helpful to focus on the benefits big data brings to your organization. As our industry works increasingly towards reducing costs and enhancing profitability, health plans have many new opportunities to make good use of the data that they are collecting by leveraging analytics.

1. New Value Frameworks

Value-based care is the future of healthcare, and the value it brings to health plans is the ability to leverage big data to improve efficiency and lower costs. By accessing analytics, health plans can hone in on newer, more precise value frameworks.

For a health plan, this can lead to actionable insights that may support pre-payment cost avoidance efforts through the development of individualized approaches derived from consumer profiles. Additionally, improved value frameworks help when health plans negotiate annual plans with providers.

Data-driven insights are so useful to health plans that Health IT Analytics classifies them as an “easy sell,” with only 17 percent of those interviewed stating that C-suite objection is a roadblock to utilizing big data.

2. Payment Integrity

We’ve reported on the importance of payment integrity for health plans, which augments fraud, waste and abuse (FWA) programs and streamlines intensive administrative processes among many other values. Health plans must address improper payments as a result of FWA, which are a core contributor to rising healthcare costs. Analytics can give insights into how and when these FWA offenses occur, allowing a plan to eliminate inefficiencies.

However addressing just FWA isn’t enough. Total payment integrity completes what we term a 360-degree solution for full-scale, holistic audit and recovery. Leveraging analytics to address comprehensive payment integrity is a huge benefit for health plans, providing more value than siloed FWA solutions. In fact, Pareo™ clients report a 10x return on investment.

3. Faster Decision-Making Ability

Imagine how much easier it is for health plans to make a decision when all necessary data is immediately available for review? On-call analytics distilled into customized reports (like those provided by Pareo) give a competitive advantage to health plans, allowing a look at the “big picture.”

For example, effective analysis of claims data in conjunction with other collected data sources can help management identify problematic or repetitive errors in a plan’s revenue processes. Consider how beneficial it may be to a Medicaid MCO attempting to improve their Coordination of Benefits compliance protocols if they are able to see how the process unfolds in their organization through analytics? These internal insights can drive change, and they are available with a total payment integrity solution.

4. Predictive Modeling

Our industry is quickly leaving behind retroactive mindsets and looking to proactive solutions through predictive modeling. Effective analysis of big data is yielding transformative shifts in healthcare, like predicting high-risk patients for ACOs and quantifying healthcare costs. These are just some examples of the benefits made possible by a predictive modeling platform.

Predictive analytics can allow your health plan to be pro-actively focused on prevention, rather than solely retrospective, pay-and-chase activities. Pareo offers clients an evolving predictive modeling platform that learns as it goes, effectively generating projections on a plan’s prospective claims data and FWA programs.

5. Transparency

Health plans can leverage big data to achieve transparency, allowing data to be made available to patients, providers and other payers as mandated. Real-time data is not only useful for compliance purposes (such as sharing co-insurance information through the COB process), but it also allows more adept claims monitoring on the part of health plans.

Transparency is a vital initiative that can fail due to a lack of comprehensive visibility. Even when a health plan has invested in third-party vendor solutions, without the ability to manage these vendors through a singular portal, data becomes siloed and difficult to share.

The Big Data Revolution isn’t something a health plan can afford to dismiss. Rather, with the proper tools, a health plan can harness big data to their advantage. Learn more about how ClarisHealth helps health plans better use their massive amounts of data by contacting us today.

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