payers

How data can help payers

by Dan Kotok

How many non-medical personal attributes do you think it takes to predict a person’s medical costs? 75? 150? Try 442. In the healthcare industry, payers are using data to make their jobs—and the consumer’s healthcare experience—easier. With data, payers can help create better health outcomes, be involved in total care management, and provide price transparency.

In part one of this series, we covered the overall scope of big data in healthcare. Now, we’re showing you exactly how payers in healthcare can leverage big data.

 

Better health outcomes

I know what you’re thinking: “How can payers use data to create better health outcomes? They’re only involved in the business side of things!” But the interaction between the payer and the provider is so close that payers really can make a huge difference in the health outcomes that patients experience.

For example, Bright Health, an integrated health insurance startup, is building a data infrastructure that “has the potential to produce better health outcomes for millions of hardworking Americans.” They’re using data to help the payer model become more consumer-centric. They recently raised $200 million in funds, evidence that their model is working.

Another insurance company rebuilding their data infrastructure is Oscar Health. They’re using data to help them prune doctors from their network, leaving consumers with fewer but higher quality choices. They’re also using data to help consumers better understand the care they’re getting.

“As [an] insurance company, we already have a lot more data than anybody else in the system,” said Mario Schlosser, CEO of Oscar Health. “Most partners and vendors in health care—the big drug vendors, the big imaging vendors, and so on—are not set up for anything close to real-time data transmission. . . . Seeing what is happening with somebody in real-time has one of the biggest possible impacts on whether that person would be willing to take advice and think differently about their care.”

As payers and consumers use data, they can make smarter decisions and improve consumers’ health outcomes.

 

Total care management

Data is helping payers create a better consumer experience at a lower cost. How? By moving towards…

 


 

Want to keep reading? Check out the complete ebook—How Big Data is Changing Healthcare.

 

Dan-KotokDan is a Senior Account Executive here at Simplus. He has specialties in Salesforce.com, training user and system testing cycles, end user and support training, business process mapping, LSS project management, implementations, and change management.

dank@simplus.com