Health Plans Need Analytics More Than Ever


 America’s health plans operate under varying business models, serve different constituencies and concentrate in distinctive markets from coast to coast. But what they all have in common is a desire to improve their overall operational efficiency, provide the best possible care to their members, and enhance their brand positioning in the market. 

That’s where analytics come in. 

More than just detailed reports, analytics are a visualization of a plan’s process and, if integrated correctly and fully, provide a holistic view of a plan’s data in ways that both deliver insight and support intelligent decision-making. While traditional reporting is focused on under-standing the past (what happened), analytics focus on why it happened and what will happen next. As such, analytics allow health plans to sort through and make sense out of its complexity of data and help these organizations in a myriad of ways that result in continuous quality improvement. 

A good analytics tool can help a health plan move from just keeping its head above water by doing what is required to opening up possibilities to find out what is needed. Where do we have inefficiencies in our process? Where do we have gaps in our reporting? How can we evaluate staff performance or staffing needs? By answering these key questions, health plans can remain audit ready, keep ahead in STAR ratings, better serve their members and better motivate their employees. 

For many healthcare organizations, embracing analytics requires a true cultural shift. Far too often employees are simply intimidated by even the thought of analytics as a tool they should welcome. Sadly, such a mindset prevents these employees from achieving their full potential. But the truth is most people can work comfortably with analytics; they just don’t think they can. 

Changing that narrative has been shown to increase employee motivation by providing staff with the “why” for what they’re doing and insight into the importance of their work. Keeping employees involved in analytics has also been shown to make them more self-sufficient, a better team player, more apt to adjust to new systems and processes, and better able to prioritize their work and remain invested in both the company as a whole as well as in their own performance. 

The value of a good analytics tool cannot be overstated nor underestimated. Fortunately, effective tools now exist that make all of this possible. In choosing the right analytics tool and business partner, a health plan should ask four questions: 

1. Is the tool user-friendly, easy to learn and not intimidating to a staff that may have inherent hesitation toward moving to this approach? 

2. Does the tool have the ability to schedule and automate reports? Standard reports should include average turnaround times per case owner, past-due cases, overturned cases missing effectuation, closed cases missing a disposition, caseload by case owner and root-cause analysis. The newest reporting capabilities also allow for further drill down within custom-built dash-boards, such as clicking on a particular case in a report to show the open tasks for that case. 

3. Will the tool produce clear and consistent reports that look for missing data or errors/ discrepancies in data, whether in the Center for Medicare & Medicaid Services (CMS) universe, other regulatory reporting or internal reporting? 

4. Can the tool provide one-click CMS universes for Medicare? Creating clean, accurate and timely audit universes that are CMS-ready can also be used as a mechanism for ongoing compliance monitoring as well as serve as a powerful tool for plans to evaluate their operational performance. 

There has never been a better time than now to embrace this cultural shift and to make sure that your health plan is reaping all of the benefits that this new era of analytics can provide. What are you waiting for? 

Jessica Sieger is product specialist and Whitney DeHaven is customer success manager for Beacon Healthcare Systems in Huntington Beach. It is home to the healthcare industry’s leading compliance and risk management technologies that support all lines of business, including Medicare, Medicaid, commercial, health insurance exchanges and risk-bearing entities. 


Jessica Sieger

Product Specialist


Whitney DeHaven

Customer Success Manager