Leverage analytics for better business decisions


Data analytics has become vital in today's health insurance environment. It not only offers insurers the opportunity to harness lots of data to effectively deter fraud, waste and abuse, it also helps them identify areas to improve quality and reduce cost.

Recognizing that, Boston Medical Center HealthNet Plan (BMCHP) has leveraged analytics to monitor emerging trends and track cost savings opportunities. The 350,000-member health plan has been investing in enhanced analytics tools to keep up with the demand for information to make good business decisions, Lisa Feingold, vice president of Clinical Informatics at BMCHP, told FierceHealthPayer in an exclusive interview.

"The more people who are looking at information, as opposed to data, the smarter the decision-making process will be," Feingold said.

FierceHealthPayer spoke with Feingold to learn more about how BMCHP uses analytics as well as the need for self-service analytics.

FierceHealthPayer:  Can you describe the health plan's focus on analytics?

Lisa Feingold: My department is within the finance area. We're the corporate analytics department, and we focus on quality measurements, including HEDIS and program evaluation for clinical quality programs we run. We support high-risk case identification in building a registry for the care management team and identification of high-cost cases.

Within other parts of the finance area, corporate analytics also supports cost and utilization trending, identification of outliers and opportunities for cost savings. We do a lot of pharmacy analytics as well, in just looking at existing trends. There are actuaries within the department who look at model cost and utilization, so when it comes time to contract with different state entities, we've got the most robust and up-to-date information.

We also try to support individual provider groups, by giving those provider groups we have risk deals with as much as information as possible, in terms of high-risk patients if they're doing care management directly and information about how they're performing on various quality care metrics.