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Perspectives

For some time now, industries like retail and finance have recognized the value of connecting with their customers on a more intimate level. They create new growth opportunities through predictive analytics and artificial intelligence (AI). It seems major retailers can accurately predict life events like marriage and pregnancy based on consumer shopping habits. But some in the healthcare industry have yet to harness this capability and take meaningful action.

While this represents a significant gap for health systems and payors alike, it’s not for lack of data. Today, the healthcare industry generates roughly 30 percent of the world’s data volume. By 2025, the annual growth rate is anticipated to reach 36 percent – the largest of any industry.

The industry captures more data in clinical encounters and lifestyle information than ever before. We have access to lab values, biometric data, risk assessments, patient records and even on social determinants of health. We know benchmarks and leading indicators. But payors and the broader industry still struggle to see these and intervene.

Why don’t we leverage all this data?

One reason: it’s hard. Especially with our current infrastructure. Despite many advances towards interoperability, a breakdown in communication remains. Many systems that store health plan and patient data don’t talk to each other the way we need them to, for example electronic health records and payor claim-based risk stratification engines. It can also be challenging to acquire the right data that helps identify the necessary insights. Not to mention managing the impacts of territorial data silos and implications of privacy guidelines.

However, the root problem isn’t an inability to get meaningful insights from healthcare data. It’s our inability to change health plan members’ behavior, which could otherwise result in improved outcomes. Whether that means maintaining or regaining functional health, this strategy can be the pathway to lowering costs. The thousands of decisions made at a macro level (plan design, network, population health initiatives) and at a micro level (individual interventions and personalized communication) impact the member’s ability to achieve those goals.

When benefit administrators and providers work together, they can create real change.

Human resource (HR) leaders must throw away their assumptions and preconceived notions to be successful. They must trust the data, even if it challenges the traditional understanding of what a high-cost claimant looks like, or what a benefit design should do. They must also understand the possible interventions.

While there are only so many levers an HR leader can pull, they must avail themselves of what they can. They must meet their health plan member where they are, and slowly nudge them to the desired end state. Finally, HR leaders need to run experiments and use measurement and evaluation methodologies to understand the impacts. Every employee population varies. Culture, access, health status and market dynamics will all make different interventions more or less effective for each plan.

Foundational to all of this is having a strong data strategy and robust analytics capabilities.

When HR leaders collaborate with their benefit plan administrator and health system’s population health, quality and clinical transformation teams, they can achieve a “triple C” win for their organization.

  • Complete – Data silos are broken down to create a complete view of members and providers – and their interactions. Data is integrated and meaningful insights are derived to steer change.
  • Cross-pollinated – The organization is able to juxtapose multiple data sources and understands the delta and what to do about it.
  • Contextual – The organization is no longer satisfied with numbers without narrative. A metric is just the beginning to understanding cause and the greater context of data.

At Contigo Health, we’re enabling health system HR leaders to focus on that “triple C” strategy.

We’ve joined forces with our parent company, Premier Inc., and their PINC AI™ platform to build an analytics offering that gives health system HR leaders a powerful new view into their data. Benefits managers can have access to an employer’s benefit plan claims data and clinical insights together.

The technology and services platform allows Contigo to bring medical and pharmacy claims data, care management, member services data, clinical systems data and provider data into a single environment. The combined data model will help health systems manage their own employee benefits plans and provider-sponsored health plans more effectively.

Contigo analytics include:

  • Insights into members’ actions and behaviors to understand what has happened within the plan. HR leaders will see a complete picture of utilization, engagement and participation. Coupled with paid claims, these insights let HR leaders understand what motivates health plan members and network providers.
  • Insights into risks and trends that highlight opportunities for change, including areas like identification, stratification, benchmarking analysis for costs, at-risk members and provider quality.
  • Outcomes and impacts to measure efficacy and make strategic choices for the plan.

The data set will also provide comparisons and benchmarks gleaned from PINC AI, powered by Premier’s more than 20 years’ worth of cost, quality and operational data. This data is gathered from 45 percent of U.S. hospital discharges.

Armed with these insights, HR benefit leaders can work with their clinical peers to make informed plan and network design decisions, deploy new programs and interventions, and drive clinical transformations. This more intimate view of members can carve a new path to improved outcomes and lower costs.

That’s data worth having.

Learn more about Contigo Health Analytics, a part of Contigo Health's Sync Health Plan Administration™ and Sync Health Plan BPO™ products.

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