Four Ways Payers are Leveraging Data to Improve Operations

Tableau, a data visualization company, recently released a report titled “How to Improve Healthcare Payer Operations with Data.” The report examines how payers are pressured to improve operational efficiencies, lower costs and drive new revenue, but can only do so with access to meaningful data insights. As a result, innovation-led payers are building agile software solutions that can provide them with the real-time analytics they need to optimize the core facets of business operations.

Four of the key ways Tableau found that payers are utilizing data to improve operations include:

1. Enabling Wellness & Disease Management
Payers are using publicly available self-service online tools, such as the Centers for Medicare and Medicaid Services website, to better understand population health across geographies. This data is being used to create geographic health segments, which targeted communications are then crafted for that speak directly to the region’s unique health needs. This data also helps payer analysts understand the scope and emerging threat of specific diseases at the zip code level, giving them an understanding of where to focus their prevention programs, as well as the ability to measure the impact of them.

Alternatively, other payers are taking a leadership role and designing their own population health management tools. The Blue Cross Blue Shield Association (BCBSA), a national group of 36 independent and community-based companies, developed a new population health index in November of 2016. The Blue Cross Blue Shield Health Index℠ is powered by claims data from more than 40 million BCBS members and measures the impact of more than 200 common diseases in order to give healthcare professionals, policymakers and community leaders insight into counties with the highest risk for chronic diseases so that they may focus their efforts to improve their communities’ health.

2. Increasing Customer Service Efficiency
Many healthcare payers offer mobile and online member portals for accessing documents and getting answers about plan benefits. The problem is that many plan members do not take the time to acquaint themselves with these available portals, and thus in time of question, they default to calling customer service. In turn, this unnecessarily overwhelms customer service resource and increases operational costs.

One payer is combating portal under-utilization with real-time data analytics. Blue Shield of California, a nonprofit healthcare payer serving more than 3.5 million members, created a dashboard that compares customer web and mobile portal behavior with call center rates. Through access to real-time behavioral data across channels, BSC found that only 12% of members access the self-service portal and that these same members drive more than 40% of the call volume, leaving $57 million in potential call center cost savings on the table. In response to these findings, BSC created campaigns specifically to educate their customers on the capabilities and functionality offered by their self-service portals. They then used the dashboard to measure the effects of their portal education campaigns and to continuously drive improvement.

3. Improving Employee Productivity
Nurse case managers often have to navigate through a vast array of different data sources in order to gain a holistic view of a patient’s health history and access to care. This manual data research and analysis results in lower productivity and higher costs. By empowering case managers with a single source of truth for each patient, nurses can have the 360 degree patient view they need to advise patients on the most effective and lowest cost treatment options offered by their plan.

Blue Cross Blue Shield of North Carolina (BCBS NC) developed a solution that blends data across 13 different sources, including demographics, group coverage, benefits, risk information, claims history, program enrollments, care gaps and group incentives. The centralized platform is now delivering a total picture view of each patient to their case managers, reducing the amount of time it takes to collect patient insights from hours to seconds so that nurses can deliver faster and better care management to their patients.

4. Powering Claims Management
Healthcare payers have to process millions of claims each year and screen them for fraud, waste, and abuse, which is often manual, tedious, time consuming, and fraught with human errors. This process involves capturing data from multiple, disconnected systems, cleansing and normalizing the data, and then analyzing the data to segment the covered patient population based on risk.
One payer, however, found that by giving claim managers access to ad-hoc analytics, answers to specific claim questions can be found more efficiently. This payer was Optum, a subsidiary of United Health Care. Optum’s Command Center dashboard aggregates claims data from its disparate IT systems, and uses ad-hoc analytics to deliver actionable insights to its C-suite, business leaders, and analysts. The system auto-alerts when a claim is ready to be expedited to resolutions, and visually maps the status of each claim at the facility and health plan level. With online ad-hoc analysis and automation, claims monitoring now takes hours instead of weeks.

As healthcare payers strive to adopt value-based care models across the enterprise, they are looking for actionable data that can increase employee productivity, lower costs, strengthen wellness management and improve the customer experience. Automated analytics platforms are making this possible, helping payers identify issues faster and act on opportunity more effectively.

To learn how actionable insights can help your business achieve operational excellence, please call 203-731-3555 or email Custom developing platforms for communications compliance monitoring, channel preference, customer journey mapping and more, our real-time reporting solutions give healthcare leaders the insights they need to oversee their customer experience with all new efficiency.

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