Stethoscope with financial statement, calculator, pen

This is the second part in our discussion about the increasing role of Analytics in the Healthcare industry. Here, we explore how Analytics offer irrefutable benefits to the insurers and try to derive a conclusion. (Please to view the first part of this discussion).

For Payers: Analytics Eases Adaptation to Healthcare Reforms
Payers can benefit from Healthcare Analytics where everything from Electronic Health Records to ICD-10 and Health Information Exchange updates can impact their expenses, profitability and marketing penetration. Typical areas where analytics are immediately useful include categorization of population health indexes, evaluating success of marketing strategies and assessing new provider networks. In addition, analytics invariably yield a more granular form of data which is better suited for disease management programs.

Better Employer Management
Traditionally, payers don’t provide much assistance to employers for ensuring healthcare compliance. Analytics can be used for checking the degree of regulatory compliance achieved and discovering loopholes. This ensures organizational policies are up-to-date with the myriad mandates emerging from the healthcare sector. Using analytics, payers can even predict employer preparedness to abide by the new set of mandates.

ROI Addressed with Analytics
Understandably, ROI is a top priority for payers. Healthcare Analytics can provide return on investment by helping payers identify health trends prevalent across different subsections of populations. Analytics help to allocate the most suitable Primary Care Physicians for programs like the PCMH (Patient-centered Medical Home). Analytics makes it easier to identify the most efficient providers in the network and optimize the current provider networks. Payer participation in the HIEs is also rising. Payers can contribute better by providing information resourced via Healthcare Analytics. This includes information about health trends prevalent across different regions, health insurance buying preferences across different age groups, success of different employers’ group coverage plans, etc.

Reform Compatibility Eased
Apart from ensuring compatibility with ICD-10, Healthcare Analytics can help payers adapt to ACA mandates that require allocating 80 percent of the premiums on patient care or on efforts to improve the quality of care. Here, Healthcare Analytics can help to identify the cost overheads, helping payers correct their spending and identify aspects of patient care that need more funding. With the ACA reforms, the individual market is set to expand further. Payers can use Healthcare Analytics for calculating retention trends too. This can help them identify subscribers who are most likely to switch to individual coverage and detect prospective consumers most likely to buy from the individual marketplace.

More to Analytics Applications
For hospitals, analytics can help prevent overtreatment or overtesting which is in direct coherence with the Affordable Care Act mandates. Predictive analytics help to identify patients exposed to greater risks in the future, allowing physicians to intervene proactively. This in turn helps to cut down patient queues and reduce readmission volumes. Some people might say that optimizing hospital care can work against profitability but this viewpoint is skewed. Just consider a simple scenario where a healthcare facility needs to send reminders about annual check-ups. Using analytics, it can easily decode the patient’s web access preferences such as email, mobile apps or social media. The reminders can be sent accordingly, raising the number of check-ins, ensuring that care optimization doesn’t eat into profits.

If used appropriately, Healthcare Analytics is a robust tool that provides realistic, immediately usable information and not just theoretical indicators. As healthcare reforms take a more holistic shape, molding the current market from its volume-centric layout to a value-focused pedestal, healthcare agencies and payers will witness more changes. Healthcare Analytics helps to determine the most probable outcomes and be better prepared for the transformation. Whether it’s ensuring compliance with legislative changes or introducing new cost containment measures, Healthcare Analytics provides the kind of business intelligence that makes perfect sense in the coming years. Analytics doesn’t seek to outsmart healthcare reforms—it merely makes it less subjective, helping the industry save more and provide better care.

Leave a Reply

You must be logged in to post a comment.