Q&A: Cost optimization and analytics, a payer’s top priorities

By Milliman MedInsight

13 February 2024

Payers face a multitude of challenges as they navigate an increasingly complex healthcare ecosystem. From improving member engagement to maximizing technology investments, pressures continue to mount. However, one challenge stands out among the rest – the relentless rise in healthcare costs.

According to a recent study conducted by EY-Parthenon and KLAS Research, cost management ranks as a top-three strategic goal for a staggering 72 percent of payers. This statistic highlights the urgency and importance of finding effective solutions to tackle the escalating costs that impact the healthcare industry.

We recently spoke with MedInsight Director of Payer Analytics, Lauren Piacentini, about the pressing issue of healthcare costs and explored how payers can leverage advanced analytics to overcome their cost management hurdles.

Q. Healthcare costs are projected to grow in 2024, fueled by inflation, utilization, and expensive drug therapies. How can payers leverage analytics to identify cost-saving opportunities?

A: Above all, having a reliable data engine is crucial for making informed strategic decisions that lead to better cost management. Payers that fully leverage their data can more effectively identify the root causes of rising costs and drive positive transformations. When health plans achieve better outcomes for their employer groups and members, they ultimately increase the value of their plans.

Payers equipped with robust analytics must go beyond surface-level analysis when collaborating with employers and delve deeper into specific populations. Even the most successful employer group will have segments within their population where outcomes are suboptimal. It is widely understood that the communities people live in have a direct correlation to their health, (e.g., disparities in maternal outcomes) therefore, it is important to continually explore geographic variations in outcomes, utilization, and behaviors. These insights can uncover opportunities to improve communication or create support systems that promote optimal utilization behaviors. These types of action optimize costs and outcomes and maximize employer group reporting value. For example, health plans can identify communities where they see above average concentrations of individuals who frequently visit the emergency department for non-emergent conditions like back pain, headache, or sore throat. By identifying these individuals and their commonalities, health plans can work strategically to reduce costly ED utilization and improve condition management through targeted interventions.

Another example of where analytics can help optimize costs and outcomes is in the utilization of glucagon-like peptide-1 (GLP-1) receptor agonists. These medications have been clinically proven to manage type 2 diabetes and are showing promise in treating obesity as well. With approximately 42% of the U.S. population affected by obesity and over 200 associated diseases, the demand for weight loss solutions is higher than ever. However, the high cost of GLP-1 medications, coupled with suboptimal adherence rates, can lead to significant financial waste for payers and members if medications are not taken as prescribed. Analytics can help evaluate the utilization of these medications, ensuring appropriate coverage and utilization for maximum benefit.

Q. What are the barriers health plans and employer groups face when evaluating action they can take to drive change?

A: Complacency and inflexibility are two potential obstacles that health plans and their employer groups may encounter during decision making. It is imperative to avoid becoming complacent, even when things appear to be going well. As new challenges emerge, payers are finding they need to maintain a proactive approach. Extracting valuable insights can be done by conducting in-depth analyses of different populations and targeting cohorts with similar needs. They may also take a broader perspective by examining data over multiple years to reveal previously hidden patterns and trends.

Given the evolving factors driving cost increases, leveraging trusted data insights becomes increasingly important to pivot to changing needs and increase an organization’s data literacy. Establishing a strong analytics foundation offers health plans a deeper understanding of the risks associated with growing healthcare costs, such as high-cost claimants and prescription drugs, and enable the implementation of effective strategies to mitigate these risks. By remaining vigilant, adaptable, and utilizing data-driven insights, health plans can help their employer groups more successfully navigate the changing landscape, optimize their approaches to cost management, and better meet the unique needs and preferences of their members.

Q. When payers want to replace or upgrade their analytic solutions, what factors should they consider when selecting an analytics partner?

A: When it comes to data management in health plans, it is crucial to move away from siloed systems and instead develop an enterprise analytics strategy. The ideal analytics partner is one that is focused on building adaptable business insights that can effectively respond to the ever-changing healthcare economy. During the evaluation process of potential analytics partners, payers should prioritize their ability to deliver platforms that cater to different levels of analytic maturity. This includes choosing to collaborate with a vendor that fosters a data-driven culture and caters to a wide range of users, including information consumers, data scientists, employer groups, and brokers. It is also important to select a partner who demonstrates that they are in tune with the specific requirements of payers and their customers due to the increasing complexities of the healthcare industry.

By establishing a strong partnership with an analytics provider that understands the unique needs of payers and can support a variety of data sharing approaches, health plans can fully leverage their data and drive informed decision-making throughout the organization.

Q. What aspects of payer analytics are you looking forward to the most in the upcoming year at MedInsight?

A: It has been a rewarding experience to witness the transformative power of our payer analytics offering and how MedInsight empowers health plans to tackle their specific business challenges with speed and efficiency.

Whether payers are looking to share valuable employer group insights or maintain a competitive edge, we’re dedicated to supporting each health plan’s journey through continuous innovation of our Payer Platform offering. For instance, we’re preparing to unveil a newly enhanced Payer Insights application that will help payers streamline analytical workflows, quickly identify opportunities for performance optimization, and visually communicate with key stakeholders across the organizations. Health plans can also take advantage of our Employer Group Insights application to maintain valuable customer partnerships and show clear opportunities to improve financial and clinical outcomes.

Another exciting development on the horizon is our focus on developing an outcome-based analysis framework. We are committed to creating clinical journey dashboards that cater to different cohorts of individuals with specific clinical needs. For example, we have dedicated pages that delve into women’s health, covering topics such as preventive care utilization, fertility treatment, pregnancy outcomes, neonatal care, and postnatal care. This positions us to collaborate with our customers in gathering data on the actions they can take to address these cohorts. By leveraging this data, we can quantify the impact of different actions, such as the duration of maternity leave, and identify the ideal course of action based on data-driven insights.

We are committed to ensuring our health plan customers are better equipped to make informed decisions, optimize their operations, and ultimately deliver better outcomes for their members.

Get started today

To discover more about our Payer Platform and how MedInsight can assist your organization in addressing present and future cost management challenges, reach out to one of our analytics experts. You can also visit us at HIMSS24 March 11 – 15 in Orlando, Florida at Booth #981, where we will display our payer analytics in action.

Learn how to optimize healthcare costs with payer analytics