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The Rise of New Age Healthcare Analytics


Payers have a convincing and growing need for analytical tools, as a new business model for health insurance is evolving in a post-health reform environment. These tools are needed to help the managers and executives understand the performances with regard to finance, operations, and clinical care. To be successful, payers need to change their business models in the post reform environment, be it the payment or delivery of care and wellness services.


Drivers for new business models for health insurance:


1. The development of value-based reimbursement methods as the U.S. CMS continues to study a variety of value-based payment models like pay for performance (P4P), episodic and bundled payments, and will develop additional regulations to meet its future goals that demand a greater share of provider payments using these models; Payers and providers need to under s tand the complete r i sk environment related to the under- writing and management of these new reimbursement models, and this is a key area for analytical tool support.


2. Emphasis on the overall value in health insurance benefits and care as measured by the combination of effect iveness and efficiency in


healthcare; The ACA has placed a financial and regulatory emphasis on patient-centered outcomes, and analytics applications on the payer side can help gather and report important information on the cost and quality effectiveness.


3. Transition to newer insurance benefit packages on exchanges, including narrow network and higher deductible products; Payer managers will continue to depend on analytics in order to determine what is working well and what is not.


It is important to accept that the trends in healthcare industry are forcing market players to adopt analytics to manage membe r e xpe r i enc e .


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