With or Without ACA, Payers Should Continue to Invest in Analytics Capabilities

With the turn of the new year and the new presidential administration, the potential repeal and replace of the Affordable Care Act (ACA) has dominated headlines and payers have been left in a state of uncertainty on several major issues. From the 20 million people that could become uninsured, to the removal of the individual mandate and corresponding spike in premiums, health plans are bracing themselves for unknown market instabilities.

However, payers should not lose sight of what they can control today: how to leverage data in a healthcare economy that is defined by value over volume. We connected with Bruce Carver, associate vice president of payer services, to shed light on how critical it is for payers to have a strong data-driven strategy in 2017 to prepare them for forthcoming regulatory changes.

Payers play a unique role in healthcare as they can offer providers access to robust data on their member population. That data, however, is not actionable without proper analytics that can identify potential cost savings via patient care gaps and high cost populations. In 2017, here are three evergreen cost saving areas to focus on:

  • The individual market –  trend where risk existed over the last three years to understand what you can take on from a cost perspective in the future. This retrospective analysis will allow payers to make strategic decisions on how to approach and cater to specific member populations, like those suffering from chronic diseases.
  • Gaps in care – identify gaps in care that are driving down value, work more closely with providers and outline strategies that can start to drive down the bad debt caused by these gaps. Collaboration with providers is the only road to quality to create a holistic patient record. Start collecting information on everything from claims and demographics to clinical data generated by the electronic health records of multiple providers.
  • High costs –establish a trajectory of where you are spending the most and use your data to analyze where that spend may be in the future and to course-correct throughout the year. No regulatory mandate will ever change the fact that payer organizations need to have a strong understanding of their profits and losses. Is there an at-risk patient population that needs more interventional resources now before they progress to a chronic condition? Are some of your high cost groups associated with medication adherence issues? These are just some questions to ask and address when examining spend vs. value. 

Whether or not the ACA remains, data is still king and leveraging that information to work smarter, faster and more efficiently should always be at the forefront of any business strategy. Simultaneously, focus on the initiatives that align with trends and your mission, such as the journey to value.

To learn more about health plan analytics tools, check out our quality management solution here. To better understand how we can help you on your value journey, reach out to us here.

MedeAnalytics

MedeAnalytics is a leader in healthcare analytics, providing innovative solutions that enable measurable impact for healthcare payers and providers. With the most advanced data orchestration in healthcare, payers and providers count on us to deliver actionable insights that improve financial, operational, and clinical outcomes. To date, we’ve helped uncover millions of dollars in savings annually.

Leave a Comment





Get our take on industry trends

Why managed Medicaid/Medicare health plans need analytics to improve outcomes

Why managed Medicaid/Medicare health plans need analytics to improve outcomes

September 21, 2021

Managed care organizations that provide healthcare services to Medicare/Medicaid members are dedicated to improving the health and wellness of these underserved populations, especially those living in rural areas.   

Read on...

Using consumer analytics to steer health-related decisions

September 7, 2021

Companies tap into what people like to eat and drink, how we purchase consumables, where we like to shop, what shows we might like to stream, whether we vote, and so on. If you have ever created a profile on a streaming application (think Netflix or Amazon), you will receive recommended books, movies and other items just as soon as you start surfing.

Read on...
Data Science into your Organization

Run: Bringing Data Science into your Organization

August 30, 2021

In this three-part series, we’ve been detailing a tiered approach to introducing and incorporating data science into your organization. In Part One: Crawl and Part Two: Walk, we discussed how to get started from scratch and start building out a dedicated data science program. Today, we’ll dive into the third and final phase to see how to grow quality, centralize governance, incorporate user feedback, and more.

Read on...
Data Science into your Organization part 2

Walk: Bringing Data Science into your Organization

August 23, 2021

In this three-part series, we’re exploring a tiered approach to introducing and incorporating data science into your organization. In Part One: Crawl, we discussed how to get started from scratch. Today in Part Two: Walk, we’ll address issues that may emerge and how to overcome them, how to build out a dedicated data science team, and more.

Read on...