“Why do I need a data activation platform?” This is often the first question healthcare payers ask when approached by an analytics solution provider. But really, why not? Who wouldn’t want to reduce healthcare costs and improve care delivery? After all, value-based care has become the mantra for payers operating today.
Payers face a myriad of challenges: disputed claims, workflow inefficiencies, claim rejection/denials, re-working, strategizing customer acquisition and retention, and launching new health plans. The key to addressing these challenges lies in the wealth of claims and clinical data the payers receive. Shifting to a data-centric, predictive analytic, and machine learning approach can help payers reduce healthcare costs by increasing efficiency. A data activation platform facilitates such a shift. It enables the payers to aggregate, analyze, and activate the claims and clinical data to improve utilization management, decision-making, and the patient and clinician experience. In fact, 74 percent of health executives said their organizations would invest in predictive modeling in 2021, as PricewaterhouseCoopers (PwC) reported.
Exploring the Role of a Data Activation Platform
Imagine, I went to Target and bought chicken nuggets or mozzarella sticks and paid using my card. The retailer would analyze the data to gain actionable insights that can predict my next visit to the store and what I would buy, based on which Target can enhance my buying experience. On the other hand, payers too have my data, but they don’t understand my lifestyle better than Target. If only they did, they would’ve raised the red flag about me having the risk of developing Type-2 diabetes or high blood pressure. A data activation platform can fill this gap.
Serving patients with a data-centric approach presents payers with a plethora of opportunities.
- Better Patient Engagement:
Memorable engagement with the users is critical to payers to acquire and retain customers. A data activation platform can store the data, extract actionable insights, and guide how the payers can apply these insights to drive better user engagements.
- Efficient Care Management:
Payers are not charity organizations. They constantly strive to deliver better care yet keep the costs low to save money on the insurance provided. As a result, payers need robust insurance utilization management in place. With a data activation platform, they can crunch claims and clinical data to predict the users’ health issues and offer the right interventions to keep them out of hospitals, reducing insurance utilization.
Compliance keeps changing. On the one hand, payers need to focus on engaging with users and helping them stay healthy, and on the other hand, constantly keep a tab on compliance changes and be compliant. A data activation platform can stay updated with compliance changes and provide insights to operate efficiently in one of the most regulated verticals, healthcare.
- Transition to Value-Based Care:
The shift from fee-for-service to value-based care is gaining momentum. The payers need to develop value-based contracts to incentivize healthcare providers to make the shift. To this end, the data activation platform can analyze the quality of care, wellness, and preventive screenings offered by the hospitals to determine the quality of healthcare outcomes and help provide proper incentives.
Make the Shift Now
Data, digital or legacy, holds huge opportunities for the payers to grow their business. But most healthcare processes are still outdated and mostly paper-based—handwritten prescriptions, paper printouts of lab reports, X-ray films, and more. First and foremost, the payers need a data activation platform to manage hybrid data. Besides, most of them have an outdated IT infrastructure, mostly analyzing the data in monthly, weekly, or 24-hour batches. Let’s consider an insured patient who is admitted to the emergency room (ER). Payers only come to know about it when the hospital reaches out to them with queries concerning ER coverage. A data activation platform is indispensable for the payers to have real-time data processing capabilities to be a part of the patient journey from the start.
To conclude, a data activation platform delivers unprecedented data storage, access, and insights to help providers proactively manage the health of the insured and provider collaboration while staying compliant.