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Payers need predictive analytics to better manage risk

New care models require new approach to connecting, interpreting data stores

In today's post-Affordable Care Act business-to-consumer insurance market, payers will sink or swim based on their ability to adopt analytics, according to LifeHealthPro.

The value-based reimbursement model is still taking shape, but its success lies largely in driving healthier outcomes and quality performance metrics, noted the article, which was written by two consultants from the firm A.T. Kearney.

Predictive analytics plays a big role in this process, as it lets healthcare organizations better identify people most likely to need care and intervene before care gets complex and costly. However, the article said, most providers lack the scale and expertise to conduct this type of analytics.

But payers do--provided they are willing to look beyond simply reducing costs and instead create value by making the most of their data. "Forward-thinking payers have an opportunity to lead the ecosystem to its desired future state," the article said.

The authors pointed to specific examples of payer-driven analytics initiatives, including the information exchange created by competitors Anthem Blue Cross and Blue Shield of California that covers 9 million patients in the Golden State. In addition, both public and private insurance exchanges use predictive analytics and decision support tools to help consumers pick plans, FierceHealthPayer previously reported.

These types of "dynamic, interconnected data system[s] of data stores" will prepare payers for their role in emerging risk-sharing care models such as accountable care organizations and patient-centered medical homes, the article concluded.

For more:
- read the LifeHealthPro article

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