Value Based Payment Models In Healthcare

1193 Words 5 Pages
Analytics for Payers
The healthcare industry historically has generated large amounts of data, driven by record keeping, compliance & regulatory requirements, and patient care. But there is a major paradigm shift in healthcare information management over the last decade, instigated by the birth of electronic medical records and medical informatics. This shift in information management is ongoing, accompanying the new focus on accountable, affordable, high quality and patient-centric healthcare. There is a need for intelligent platform that is focused on helping healthcare organizations embark upon this new era of medical services by leveraging analytics and big data.
Trend in Healthcare Industry and need for Analytics
A new health insurance
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The development of value-based reimbursement methods as the U.S. CMS continues to study a variety of value based payment models like pay for performance (P4P), episodic and bundled payments, and will develop additional regulations to meet its future goals that demand a greater share of provider payments using these models. Payers and providers need to understand the complete risk environment related to the underwriting and management of these new reimbursement models, and this is a key area for analytical tool support.
2. Emphasis on the overall value in health insurance benefits and care as measured by the combination of efficiency and effectiveness in healthcare. The ACA has placed a financial and regulatory emphasis on patient-centered outcomes, and analytics applications on the payer side can help gather and report important information on the cost and quality effectiveness.
3. Transition to newer insurance benefit packages on exchanges, including narrow network and higher deductible products. Payer managers will continue to depend on analytics in order to determine what is working well and what is
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MEM leverages a central analytical engine that will provide a 360O view of the customer.

Ensuring a positive customer experience is one of the foremost tenets towards achieving higher satisfaction levels and gaining customer loyalty. By disseminating information real-time and maintaining consistency across all the customer touch points, health plans are slowly but steadily travelling down the tough path of managing customer experience and creating the `WoW’

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