Members have more insurance choices than ever before resulting in greater sensitivity and less stickiness to plans and providers. In the ever increasing competitive landscape of the global health insurance market, payers need to offer patients the services they want and need by moving to a value-based approach. In the current fee-for-service model of reimbursing providers for health care, providers are incentivized to do more – see more patients, order more tests, perform more procedures. Volume does not always equate to better care. Instead of focusing on the patient, providers are focused on the bottom line.
To shift the focus back to the patient, payers should adopt a reimbursement system that is value-based. Through data, patients can understand the effectiveness of a course of treatment and its cost. This empowers patients and payers to make informed choices for the best possible outcomes. Value-based care is measured in terms of long-term successes such as the reduction of readmissions and other quality factors that suggest improved overall health.
Throughout the member lifecycle, health plans guide members to a deeper understanding of the healthcare system, letting members choose the plan, the providers, and the options that offer the best possible effect on their care outcomes. It is not about inventing channels as a reaction to member demand. Instead, the most operational engagement programs arise from an alert, thoughtful answer to the requirements of the members.
Healthcare insurance organizations can reap multiple benefits from using analytics creating an atmosphere favorable to retain, acquire, and manage members. Providers must foster an analytics-driven culture that can minimize administrative costs required to develop strategic member acquisition plans from various sources such as EMRs, claims, social and web data. Knowing and acting on the resulting data-driven insights are key to any healthcare insurance system’s commitment to manage member experiences for retention, acquisition, and recapture.
Next generation analytics solution for healthcare payers
Designed for healthcare payers, IntelliPayer identify gaps in care and put an emphasis on member wellness, including identifying and engaging high-risk patients
- Member Engagement – By implementing effective data management and analytics solution, payer companies can develop a strategy to manage member retention, acquisition and recapture.
- Claim Management – Claim analytical solution allow payers to better understand and manage critical components for improving operational effectiveness, claim processing and member retention.
- Provider Management – Scalable Health provider management solution helps payer companies to promote improved outcomes and cost containment including evidence-based medicine (EBM) and pay for performance (P4P).
- Care Management – Care management solution minimizes patient’s unnecessary visits to the physicians while ensuring accessibility and results in improved quality of care.
- Disease Management – Disease management solution emphasizes on the prevention of complications using evidence-based practice guidelines and patient empowerment strategies while evaluating clinical outcomes to improve overall health and quality of life for patients.
- Fraud and Risk Management – Fraud and Risk management solution facilitates more accurate detection, prevention of fraud and management across the functional areas of the healthcare industry.
Scalable Health provides analytics solution to organizations to extract insight from their enterprise data, identify fraudulent claims, and demonstrate the value of evidence-based care. It accelerates the discovery of critical insights from complex data to help control cost and improve the quality of patient care.