Payers use clinical analytics to drive down costs

Healthcare payers and providers are using clinical analytics to lower healthcare costs, according to a new study from HIMSS Analytics.

The payer respondents are analyzing data from a wide variety of sources, including laboratory data, pharmacy data and claims data. By improving care coordination, through health insurance exchanges and other means of data sharing, payers can access information that will help them establish preventive and wellness guidelines and identify areas in which fraud, waste and abuse can be targeted and eliminated.

Clinical analytics can also help reduce healthcare costs by providing data for the creation of integrated wellness programs. These programs may reduce hospital admissions by allowing patients to receive preventive care, which is less expensive than treatment and interventions.

Payer respondents also reported looking at and analyzing data across all of their insured patients, particularly identifying causes that put patients at risk for readmission. Additionally, payer organizations reported analyzing data directly tied to the cost of care, including underwriting policies, identifying instances of fraud and abuse, and predictive modeling.

One area of data sharing that does not seem to be in place is sharing between payers. None of the payers represented in this research said they shared data with other payer organizations. HIPAA restrictions were cited as some of the key barriers to sharing information between payers.

To learn more:
- read the HIMSS Analytics study

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