Healthcare
Understanding the pivotal role of data analytics in healthcare payer operations
As a leading global accounting and consulting firm suggests, health organisations can revolutionise their operations by harnessing the power of data analytics and digital transformation. This strategic move can lead to a deeper understanding of patients’ behaviour, bridging health equity gaps and, ultimately, creating greater value and driving commercial excellence.
It is important to note that a payer’s socioeconomic factors directly influence health equity. To tackle this, healthcare institutions are reshaping their operating models to collect and manage patient data. The integration of advanced data analytics, automation, and AI empowers them to deliver patient care based on priority through segmentation and an omnichannel approach, promising a more personalised and effective healthcare experience.
In this article, we learn the benefits of healthcare payer analytics and ways to build a strategy.
Benefits of data analytics for healthcare payers
Historically, the healthcare industry has struggled to leverage its massive data to derive valuable insights and improve operations and revenue. Advanced data analytics driving operational efficiency and a payer’s financial experience in the following ways –
Easy management of finances and payments
Data analytics is crucial for the payer’s journey from registration to collection. Healthcare institutions can understand the patient’s financial circumstances better and can provide accurate estimates and payment plans. Timely patient communication and transparent
pricing reduce the chances of any surprise billing. A data analytics solution helps payers through –
Faster and easier claims processing
According to a report, 42% of insurance providers said that the number of claims denials has increased and increasing this was the top pain point. Data analytics use predictive analytics to gauge market changes and improve the claims rate through –
- Automated claims – Healthcare institutions can reduce rejection rates by submitting error-free and clean claims to the payer or the government. A single-window web application allows providers to analyse claims, insurance eligibility, and payer compliance easily. Staff can prioritise workload and focus on tasks that require immediate attention.
- AI optimisation – AI enhances claims processing before submission and after denial. The system leverages data analytics to adapt to changing payer rules and customise itself to prioritisation thresholds.
Patient information and insurance verification
Data analytics solutions help insurance providers track and verify missing patient data, including coverage, to optimise collections and boost revenue. By utilising automated and real-time verification, insurers can reduce delays and denials, improve cash flow, and accelerate payment clearances and reimbursements.
Targeted collection helps providers route accounts to the right collectors, thus reducing the overall costs. They can also look for unidentified coverage, maximising reimbursement revenue and reducing accounts sent to bad debt and collections.
Building an analytics strategy for healthcare payers
Healthcare institutions must leverage an analytics model to democratise data and foster a data-driven decision-making culture.
Assess current capabilities
Conduct an analytics readiness assessment and ensure that the expectations align with capabilities. Your analytics partner will help you conduct analytics readiness assessment through –
- Organisational readiness, demand, structure, and financial alignment.
- Tools, data sources, and workflows evaluate the strengths and opportunities to meet business objectives around analytics and reporting. Map each step in the acquire, analyse, organise, standardise, and delivery model with industry standards.
- Identify the staff’s skills within reactive, descriptive, and prescriptive contexts.
Tailor the data analytics adoption plan
Establish a customised healthcare analytics model roadmap based on the organisation's readiness score. Generate a list of short-term and long-term recommendations based on people, processes, and technology.
By having a strategic approach to data analytics implementation, healthcare institutions can reduce expenses, increase revenue, and retain staff.
How can Infosys BPM help?
Infosys BPM leverages profound domain expertise in healthcare business process solutions, a highly adaptable operating model, and seamlessly integrated IT-BPM solutions to proactively address the evolving dynamics of the healthcare industry. The innovative approach to healthcare BPO is designed to transform existing operating models, elevate overall business performance, and standardise processes within the healthcare sector, all while significantly reducing operational costs.
Through the strategic integration of cutting-edge technology and agile methodologies, Infosys BPM empowers healthcare organisations to navigate complex challenges with efficiency and precision, enhancing overall business processes and outcomes in the healthcare industry.
Read more to discover how Infosys BPM can revolutionise your healthcare operations.
