Why Big Data can be a Game-Changer for Medicare Advantage Plans

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Big data analytics is a high priority for most payers, but a recent survey found many don’t feel ready to succeed with such initiatives in the current year.

Payers shouldn’t wait too much longer, however. The health care sector has been slower than some to harness big data, but it’s beginning to catch on. Health care providers and payers are analyzing data from electronic health records to identify high-need, high-cost patients, develop targeted interventions, improve population health, coordinate care and support the transition from fee-for-service to value-based care.

Payers have access to troves of data that can be used to improve efficiency, health coverage, patient outcomes and subscriber engagement while reducing the cost of care. But these benefits will be realized only if payers have the right platforms to analyze their data and to turn those insights into action.

Big Data and Medicare Advantage

Strategic use of big data can be particularly helpful as a way for Medicare Advantage plans to trim costs and boost efficiency. Andrew McAfee and Erik Brynjolfsson of the MIT Sloan School of Management found companies that say they use data-driven decision support have better financial and operational results. In fact, “companies in the top third of their industry in the use of data-driven decision making were, on average, 5% more productive and 6% more profitable than their competitors.”

An MA plan that improves productivity and profitability will have a major advantage in a highly competitive market with notoriously tight margins. Even small gains in efficiency can translate to savings, which can be passed on to members in the form of lower premiums or better benefits.

And operational efficiency is not the only area where big data can bring savings. A good data analytics strategy is a critical driver of success in value-based care. In a health plan survey from HealthScape Advisors, 70% of plans said data/analytics is effective in supporting value-based payment models.

Big data comes into play as plans set incentives for members and promote healthier consumer behavior. For example, it can help identify high-use and readmission patterns among members. Once individuals are identified, dedicated care managers can be assigned to guide them, and analytics can even determine which intervention is most likely to deliver a better outcome.

Meanwhile, behavior data, benefit-use data and disease progression data can help plans predict cost and risk metrics for new enrollees, as well as predicting the impact that changes to premiums, copays and pricing could have on enrollment, notes Pareto Intelligence.

Finally, MA plans may want to take a page from retailers’ playbooks on big data analytics and use it to enhance customer engagement and offerings. Big data can be analyzed to better understand and segment consumers, and to develop personalized consumer profiles for outreach strategies based on needs, preferences and priorities. Insight at the fingertips of customer-facing professionals enables more effective interactions and better member experience.

Getting Started

Deloitte advises payers to act now to make the transition to big data. Those interested in beefing up their data analytics should focus on:

  • getting senior leadership support and selecting an analytics leader for the organization
  • setting strategic business priorities for analytics
  • aligning data strategies for both current and future needs
  • creating a data quality and governance framework
  • creating an enterprise-wide organizational model for analytics.

While payers may not feel ready to succeed in this area, they don’t have to move forward alone. Payers can partner with a trusted vendor to implement a strong big data strategy immediately, using purpose-built tools and cutting-edge analytics. These tools go beyond alerting companies to new trends – they make data actionable so payers know how to optimize customer touchpoints, personalize plan offerings and maximize their efficiency.

With the right partner, payers can take their data analytics to the next level and strategically apply their insights across all areas of the organization. Plans that take advantage of this opportunity will see improved operational efficiency, lower costs and the ability to provide better, more tailored benefits to members.

Convey Health Solutions focuses on building specific technologies and services that can uniquely meet the needs of government-sponsored health plans. Convey provides member management solutions for the rapidly changing health care world. 

 

 

 

First seen on SmartBrief.