Navigating payers’ top challenges: 3 strategies for success

By Milliman MedInsight

22 April 2024

The healthcare industry is on the precipice of a transformative era. As payers increasingly face a multitude of complex challenges, they are finding themselves at a critical juncture. One where they must navigate these issues alongside innovative, and sometimes, uncharted territory (e.g., emerging technology).

At the Becker’s Spring Payer Issues Roundtable, Milliman MedInsight (MedInsight) collaborated with leading organizations to shed light on the pivotal factors influencing payer strategies. From payer-provider collaboration to technological advancements, we have compiled the key themes that stood out during this engaging roundtable event.

Driving digital transformation & personalized care

Digital transformation is a critical process for health plans to modernize their business and architecture and better align with market demands and member needs. Improved data infrastructure and the adoption of generative artificial intelligence (Gen AI) is increasing among health plans, presenting opportunities to enhance their operations, decision-making processes, and value delivery.

In addition, digital transformation offers unprecedented possibilities to further personalize member outreach and establish more meaningful connections. Member challenges like app and portal fatigue have raised the need to simplify actions for individuals. With Gen AI, health plans can effectively segment their audience and customize their care delivery programs accordingly. This approach strengthens health plans’ relationships with their members and leads to improved satisfaction, engagement, and outcomes.

Enabling greater transparency & trust in value-based care

To succeed in value-based care (VBC), payers and providers must have a clear understanding of what matters most. Transparency is vital for collaboration in achieving shared goals like cost reduction, member satisfaction improvement, and population health enhancement. Health plans that actively share data and methodologies with their network providers can greatly improve outcomes and reduce both clinical and financial risks.

That is why trust is the foundation for effective payer-provider collaboration. Under a VBC arrangement, health plans are tasked with managing multiple provider groups and creating the bridge from fee-for-service (FFS) to VBC. This transition requires a major shift in healthcare management and reimbursement. However, many outdated systems built for FFS models are unable to support this change. The scale of VBC arrangements also introduces significant variation, calling for the use of scalable data and technology to monitor and drive high-quality care.

Building a solid data infrastructure

Data management and interoperability remains a top issue for health plans. The extensive volume of data collected from various sources, including claims, clinical records, and member information, takes additional time and resources to standardize. To effectively leverage data, it is crucial to establish a strong foundation. Without a solid infrastructure in place, it is impossible to be satisfied with the quality of the data and its downstream impact. It is essential for health plans to get back to basics and assess the core components of their data ecosystem. Do they have proper data governance in place? Do they have the right team and workforce with the necessary competencies? Without these foundational elements, reliable models and insights cannot be achieved. Investing in these fundamental aspects is key to unlocking a health plan’s full potential of their data and building greater trust with healthcare partners.

Supporting payers’ digital transformation journey: Milliman MedInsight Role

Our core mission at Milliman MedInsight, as a data confidence organization, is to provide our clients with trustworthy data. It is a crucial first step in enabling digital transformation and adopting advanced technologies like Gen AI. As such, we are dedicated to adding context to data and creating accessible analytics that facilitate data storytelling for the benefit of various end users.

The MedInsight Payer Platform, powered by industry-recognized methodologies, serves as a scalable solution that can:

  • Provide data integrity throughout the organization to create a reliable and accurate single source of truth
  • Optimize collaboration, efficiencies, and outcomes across departments by aligning operational, clinical, and financial models
  • Increase performance, satisfaction, and profitability with meaningful insights for maintaining a competitive edge

Furthermore, Milliman MedInsight has a successful track record of collaborating with major electronic medical record (EMR) vendors such as Epic and Cerner. In addition, our recent transition to the Azure cloud has further expanded our capabilities with electronic health record (HER) integration. This collaboration sets the foundation for population health improvement strategies, value-based care maturity, and user adoption across the enterprise.

Join our Payer Outlook webinar

Gain additional insights into the payer market by registering for our upcoming “Payer Outlook” webinar. Join industry experts April 30, 2024 from 11am – 12pm PT to learn about emerging trends that are shaping the payer market. Register now to secure your spot and stay informed on market trends.

Contact us to learn more about healthcare data analytics