Report: Insurers use data to drive value-based contracts, identify gaps in care

Payers are using data analytics to control costs and drive population health.

Health plans are taking a broad approach to health data, using a massive repository of digital records to drive value-based contracts, predict patient conditions and improve population health.

A new report released by the National Pharmaceutical Council and Avalere identified seven ways health insurers are using patient data and analytics. Those approaches range from basic to sophisticated, but all revolve around the goal of improving care and reducing costs.

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In some cases, patient data is furthering value-based payments among private insurers and altering physician networks to include top-performing physicians. Value-based contracts often include specific metrics that are tailored to physician performance. These contracts also spill over into the pharmaceutical industry where payers are more willing to cover high-priced drugs if there is evidence of better outcomes.

Beyond coverage agreements, health plans are wading into the clinical arena, using predictive analytics that can sift through claims data and patient records to find gaps in care or predict instances where patients may develop certain conditions or benefit from alternative treatments. Similarly, population health management is now driven by insurers that can monitor specific metrics tied to chronic conditions.

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Providers have indicated they want to focus on population health management but see the insurance industry's inability to quickly adopt risk-based models as a primary hurdle. Meanwhile, payers view data analytics as a crucial element for population health.

The report also identified several promising trends for future data usage among payers, including data layering that incorporates wearables and remote devices, as well as increasingly sophisticated modeling that can shape provider networks.

Data-sharing was a key element in payer-provider collaborations in the last year in an attempt to rein in costs and steer patients toward high-quality providers. Health plan leaders have said data and value-based care are both top of mind in 2017.