Analytics: Pumping New Life info Healthcare Payers

Ever since President Obama declared war on US healthcare costs in 2011, healthcare payers have been pushed into the limelight and forced to act.

The marketplace is essentially undergoing a transformation to add new business models (B2C) and customer groups, introducing new regulatory standards for operational efficiency (medical loss ratios), changing operational requirements (ICD-10, EHRs), and, most importantly, starting a manhunt for reducing fraud, waste and abuse-related expenses. Analytics is applicable to each of these areas and is starting to make payers’ lives significantly better by reducing cost, increasing operational efficiencies and long-term profitability.

Our research finds that this is made increasingly possible by mature analytics solutions that strongly impact core payer business areas of member management, operations and risk, provider relationship management and care management.