An ocean of data & a desert of insight: transforming healthcare payer data into strategic insights

By MedInsight

28 September 2023

From claims to EMRs to lab and third-party data, healthcare payers have more data than ever at their fingertips – over 2.3 zettabytes per year according to a Statista projection. And healthcare data continues to grow.

The value of data-driven insights for payers is undeniable. Yet, many payers struggle with transforming mounting data into data-driven insights that can be used to drive value-based care and improve patient outcomes, efficiency, profitability, and market competitiveness.

With the right healthcare data analytics platform, you can aggregate data from a multitude of sources, instill trust in your staff to use it, and transform that data into insights that can be used to improve organizational performance – whether you work for a commercial, Medicaid or Medicare Advantage Plan.

The challenge: the need for timely, integrated data

Working with pools of disparate data that are not easily aggregated is the biggest challenge across every category of payer. If you have multiple claims systems and only a rudimentary system for making them work together, you have complications. Add eligibility, clinical, lab, and third-party data (e.g., code updates, pharmacy prices) and you have silos instead of meaningful insights.

Many healthcare payers have some technology pieces in place – often Microsoft Excel combined with a data warehouse, reporting tools, and maybe business intelligence (BI) software – but trying to aggregate data and gain insight with this approach can be like trying to build a car out of spare parts.

Why settle for performance benchmarking, cost and utilization analysis, and care management analysis that only sees part of the picture – especially as the growing availability of EMR, lab and third-party data magnifies the potential of actionable data and improved decision making?

Commercial health plans

Top priorities for health plans include offering affordable, accessible high-quality care and demonstrating value to their employer groups and members. Employers require reporting, employees want sufficient provider coverage, and everyone wants better health.

Healthcare data analytics software can help you show employers and their employees your network coverage, improved employee health outcomes, and why they should pick your plan.

Medicaid plans

Since rates for Medicaid reimbursement vary per state, healthcare analytics helps payers tell their data story to help make the case for better rates. Analytics can also help you negotiate better rates with providers in new states where you haven’t operated before.

Additionally, analytics can help you track those who no longer qualify for Medicaid.

Medicare advantage plans

Similar to Medicaid, healthcare analytics can assess individual HCC risk scores more accurately. This helps payers identify risk adjustments and negotiate better rates with the Centers for Medicare & Medicaid Services (CMS) for higher risk populations to defray their higher claim expenses.

Doing so can improve financial performance for Medicare Advantage plans and can provide back-up should you need to defend what is sent to CMS during an audit.

Note: MedInsight has a variety of analytic methodologies and supplemental services that typically identify diagnosis codes that the health plan was not aware of. In turn, this improves the chances of more accurate reimbursement from CMS.

Using trusted data & analytics

When you’re using the right analytics platform, the ability to aggregate data efficiently is just the starting point. With a credible, single source of truth, payers now have confidence in the data and can focus on extracting insights that can help improve patient outcomes, resource utilization, and financial improvement – and create a competitive advantage. Many vendors make the “single source of truth” claim but only MedInsight leverages the Data Confidence Model, Milliman’s proven and trusted methodology to ensure the highest data quality.

With the right analytics platform, you can say goodbye to running and re-running data to reach consensus, manual reporting and maintenance, convincing stakeholders that the underlying information is trustworthy. You will not have to lose sleep wondering if your numbers are trying to tell you something just beyond your grasp.

Make data-driven decisions with MedInsight

Aggregating disparate data sets into actionable data isn’t easy. But at MedInsight, it’s something we’ve been doing for health plans since 1997 as MedInsight. With deep expertise with health plan challenges and analytics, we combine a state-of-the-art analytics platform with actuarial and problem-solving experience to develop a healthcare data analytics center of excellence.

MedInsight Payer data analytics software is easy-to-use, customizable, integrates with most EMR systems, and is designed to turn sophisticated queries into answers you can use to tell compelling data-driven stories.

Quality analytics and a platform tailored to your business are the difference between oceans of data and oceans of insights. Contact one of our payer analytics experts to learn more about transforming your data into your advantage.

Contact us to learn more about healthcare data analytics software