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3 Ways Health Insurance Providers Leverage Data

posted by AHIP

on August 27, 2018

Adapted from an AHIP Institute presentation by Josh Schoeller, SVP and GM, Lexis Nexis Healthcare

There is no shortage of insights buried in traditional and non-traditional sources of healthcare data. Using member identity, claims, and provider data in a meaningful way can have a tremendous impact on health outcomes, provider behavior, and member engagement. Here are three ways health insurance providers use this wealth of information to improve the health of the consumers they insure and their operational efficiency.

  1. Address Social Determinants of Health for Better Health Outcomes
    Member health is impacted every day by social, economic, and environmental factors. These factors include distance from health care providers, income, whether transportation is readily available, whether healthy foods are close by, and more. In fact, social factors account for one in three total deaths in the United States each year. Better understanding of social needs of the communities they serve can help insurance providers improve the health of the communities in which they live and work.
  2. Building Networks that Provide the Right Care in the Right Place
    With an improved understanding of the competitive landscape at the provider and procedure level, health insurance providers can better allocate resources to maintain network adequacy.
  3. Analyzing Health Care Quality to Meet Value-based Care Expectations
    Health insurance providers can analyze data to learn how individual provider or facility performance differs, and how variations in performance impact consumers’ health cost and provider reimbursements.

You can hear more insights on unlocking the power of data at AHIP’s Consumer Experience & Digital Health Forum.