The Promise of Payer Data Analytics

Most health insurers will tell you that data analytics is the key to future growth.

But here’s the problem: many payers’ data platforms aren’t up to the task. In fact, they’re falling behind providers’ platforms in a variety of ways. 

Payers’ platforms need to be robust and scalable, but far too often they’re not intuitive to use, are costly to maintain, and aren’t designed to deliver the advanced analytics now required. A typical payer platform is great for reviewing existing data, but not very useful for creating new, rich data sets.

How do payers remedy this situation? The first step is to make sure that the platform is designed to meet the payer’s broad business and technology goals in concert. Any effective redesign of an information architecture should enable an insurer to leverage up-to-date capabilities like self-service reporting and analytics.

The business and technology design should include future-proofing the platform so business processes can grow with the organization in a flexible and responsive way.  Additionally, the insurer must modernize its information capabilities to better support its providers and patients.  This phase of an initiative often involves building a data foundation with core subject areas derived from data from several health plans across several regions, depending on an insurer’s business spread.   Modeling and designing this correctly will allow future tools and processes to adapt and interface with external data more easily.  

In addition to the internal health plan data which must be incorporated, insurers must consider how the new platform will integrate with in-house, provider, and other external systems. 

The challenges for insurers are many: existing information platforms that might need to be repurposed; the development of a new set of information and business imperatives to drive the initiative; connecting existing systems to the platform; and the reality that the insurer’s business cannot stop to make all these changes, so the entire initiative must occur in-flight.

Finally, insurers should consider using an agile development methodology, as the goals of the initiative are too large to tackle at once.  A better approach is to split the challenges into smaller challenges which can be solved in shorter iterations.  Through an iterative approach, the full software development life cycle is replaced by smaller iterative cycles allowing for course corrections with less risk to the overall project.  

The team composition should differ in quantity and quality from what one might expect of a project of this magnitude.  The focus should be on a smaller, but more capable, team composition. That means building a team composed of strong generalists who are bilingual in both business and technology.  Team members must also have considerable domain knowledge to allow nimble but thoughtful decision making, and for keeping the end vision, and the benefits it brings, in mind.    

Putting this all together in the right kind of way is far from easy. If done effectively, however, a health insurer can create a platform that’s ahead of the curve – well-positioned to meet the challenges of value-based care and advanced analytics.

Matt Flores is an architect for X by 2, a technology consultancy focused on the practice of architecture for the insurance and healthcare industries based in Metro Detroit.