Having access to clinical data and being able to predict member risk are key component to lowering the cost of claims for health insurers. But clinical data alone is not enough. You must have a holistic member view in order to predict which consumers are most likely to file claims while finding ways to offer the right consumers lower prices.
As more insurance providers move to a value-based model, quality scores are becoming more important as they reflect operational efficiencies between payers and providers. With the value-based care model, providers are no longer focusing on paying for services delivered; instead reimbursement is tied to quality of care. Value- based care aims to advance the goals of providing better care for individuals, while improving population health management strategies, and reducing healthcare costs.
Value-based reimbursements use numerous measures to determine the overall health of populations. Everything is driven by data as providers must report to payers on specific metrics and demonstrate improvement. Providers may have to track and report on social determinants that impact a member’ risk for high cost care, including: hospital readmissions, adverse events, population health, patient engagement, and more. As such, a single member view is needed.
Tools today have the ability to show a comprehensive view of each member, including an understanding of who the member is beyond their clinical profile, as well as visibility into each care interaction. A single, comprehensive view also allows for coordination of care-related communication across the entire health continuum which leads to not only improved satisfaction and outcomes, but also higher quality scores and improved financial performance. In addition, a 360˚ view of the member allows providers to spot potential problems before they have a big impact and to remedy the situation before quality scores are affected.
On Thursday, August 17 at 2pm EST, AHIP (America’s Health Insurance Plans) will sponsor a webinar with guest speakers, Michael F. Wilson, Director of Marketing, Industry Software Solutions at Pitney Bowes, Chuck Kane, Managing Director, Single View of Customer Solutions, at Pitney Bowes, and Jim Dwyer, Senior Vice President at RCG Global Services to discuss the importance of having a holistic single view of all your member data, how to achieve it, and the benefits realized from having a single view.
