Healthcare payer analytics uses technology – automation, real-time data, AI/ML, and predictive analytics – to analyze data from different sources and across systems. They produce insights to help payer organizations formulate better health care plans, assess risk, control healthcare costs, improve care gaps, increase provider satisfaction, and optimize provider networks. Healthcare payer analytics combine payer data with structured data from provider networks to analyze patient demographics and medical history. An enterprise analytics platform harnesses available data generated from healthcare systems to help payer organizations improve financial, business, and product outcomes. Enterprise analytics allows payer organizations to extract data from more extensive data sets with the help of data mining, graph analysis, and predictive modeling. These analytics techniques can track the customer journey, helping payers optimize service capabilities and healthcare management.
Payers use analytics to keep up with complex healthcare processes and understand customer demand changes. Advanced analytics extract claims and clinical data, keep payers updated on patient health and evaluate enrollment rates and medical loss changes. For example, real-time data gives payers insights into consumer interests and motivators that predict changes to membership plans, helping insurance organizations perform better in the marketplace. Insights can be leveraged to create medical information databases to chart disease progression. Payers can use the results from these databases to improve provider care programs and increase healthcare access for high-risk patients.
Health insurance organizations are investing in analytics to improve in member experience by measuring application rates of products and services. Analytics can also be used to measure lab data, Electronic Health Records, and prescription adherence to help providers calculate changes in patient demand for health services, i.e., telehealth or remote monitoring. Real-time data insights can improve collaboration among clinical and administrative teams when evaluating health plans and tracking plan performance. Consumer analytics help payer organizations assess vital areas that enhance understanding of the services and experiences that drive down reimbursement rates. Payers can determine what services are in high demand, improving the cost of care and investing in providing services that have proven patient satisfaction rates.
Healthcare payer analytics can be used in several critical areas, including:
Optimize payer performance across efficiency, quality, and costs