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Why is it so hard for health plans to find quality data analytics solutions?

While healthcare is famously complex, it shouldn’t be as hard as it is for health plans to find and manage advanced analytics solutions that take advantage of their unique opportunities and address their specific challenges.

Yes, health plans have the challenge of engaging with individual and group plan members, employers, hospitals, physicians and other providers, pharmacies, regulators, government agencies, other insurers, benefit managers, manufacturers and more. But with challenge, comes opportunity for those willing to embrace big data.

Health plans present a true “gut check” for data analysts. When you look at all those potential stakeholders, are you dismayed by the challenge, or are you excited by the opportunity? Are cross-functional applications and data something you work to limit because of risk, or do you embrace them for their potential value? Do you see complexity, or do you see a diverse set of data sources that can be harmonized to create value and solve problems?

We know where we stand. Here at Reliable Software, we look at a health plan’s array of partners, customers, vendors, influencers, regulators and payors as an opportunity to accomplish great things. It’s all in the organization and coordination, which is why our work with health plans focuses on “data harmonization” rather than simply on traditional data management methods such as data warehousing or governance structures. Those concepts do matter, but limiting a health plan data analysis strategy to those tools means limiting the final outcome to less than its full potential.

When we talk about data harmonization, what we broadly mean is the alignment of data – from whichever source – with organizational function. It’s that function that has strategic primacy, not the data or the data source. This model unlocks a variety of powerful opportunities for analytics using cutting-edge machine learning and artificial intelligence tools.

For instance, consider the long-standing health plan challenge of Coordination of Benefits (COB). A data governance and warehouse-focused model will limit the potential contribution that analytics can make to this critical function. But in a harmonized data environment, COB can be the organizational function at the center of a rich, harmonized symphony of data. That’s the kind of environment in which a COB solution such as Reliable Software’s Lia Healthcare can leverage the power of deep neural networks and constantly-evolving machine learning to turn the entire process around, driving huge recoveries by using members rather than individual claims as the starting point for a scored COB process.

Want to talk to someone who views your health plan’s data as an opportunity rather than a challenge? Contact us today to learn more.


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