Every AI initiative at a health plan runs on member data. When one member looks like three people across claims, enrollment, and engagement, the model learns the wrong lesson. So does everything built on top of it.
This checklist gives payer data, IT, and member experience leaders a fast way to find those gaps. Work through five sections in one sitting:
- Member identity foundation
- Provider network and directory accuracy
- Quality, Stars, and risk adjustment readiness
- Payment integrity and fraud readiness
- AI and analytics governance readiness
Each item pairs a concrete check with the reason it matters. Anything you can’t check off is your starting point.