Health Plans: Determine Your Digital Value Proposition

New interoperability rules will soon make it possible for members to obtain and manage their healthcare data at the touch of a smartphone. The same rules will also mandate greater flow of data among healthcare organizations across the continuum. The question is: How will health plans leverage data interoperability to strengthen the member experience?

The 21st Century Cures Act sets standards for secure and seamless exchange of data among payers, providers, and consumers. For health plans, the ability to marry members’ clinical, financial, and demographic data into a single source of truth presents tremendous potential to provide a highly personalized member experience.

We’ve already seen exciting examples of the ways in which expanded access to data can transform the member experience:

  •  A New York health information exchange (HIE) sent data regarding members who had been tested for COVID-19 to every healthcare provider it contracts with as well as public health officials. The data improved health outcomes by alerting providers to members’ existing conditions at the point of care. When social determinants of health data indicated that members lacked stable housing, providers used this information to help connect members with housing resources, reducing members’ health risk.
  • One health plan with more than 50 million members struggled to match supplemental clinical data, such as laboratory results, to its members. Poor data quality affected quality reporting accuracy under HEDIS and the Medicare Star Rating System. Verato worked with the health plan to strengthen member identification for laboratory and other supplemental clinical data. The impact: a more complete picture of each member's clinical outcomes led to more customizable and improved member experiences. Plus, 99% of quality measures improved across 21 state Medicaid programs, leading to $10 million in incremental incentive revenue for the health plan.

Consider that the ability to manage population health starts with data integrity: understanding the behaviors that increase health risk and cost and the interventions needed to improve health. When health plans struggle to match clinical, financial and demographic data to their member population, they miss vital opportunities to pair members with interventions that could reduce health risk, as the organizations highlighted above have done. They also struggle to engage members in improving their health.

To find out more about what the 21st Century Cures Act means for health plans and how your organization could use data interoperability to strengthen the member experience, join Verato for our presentation with FierceHealthcare, “Health Plan Roundtable: Consumerization and Legislation.” You’ll gain insight from three health plan executives. Learn more and listen today.