By: Donna Holmes, Senior Vice President, Optum Advisory Services
This is the 5th blog of our eight part series “Bending the Cost Curve with Comprehensive Sourcing.”
Reducing total cost of ownership requires a keen understanding of the health plan’s cost structure and the ability to identify the value drivers that can be improved. Are you paying claims appropriately? Is a provider consistently delivering quality outcomes? Do you have clear insight into your population demographics and provider practice patterns?
The modern health plan automates activities and tasks across the health care value chain, which enables collection of actionable data to reduce operational and medical costs. This business intelligence creates the foundation to drive key decision making for all stakeholders able to influence total cost of ownership.
Maximizing points of value across the health ecosystem
From members to providers, there are many opportunities to influence total cost of ownership through business intelligence. Members, for example, benefit from decision support tools that help inform their choices and more effectively access care appropriately.
Providers need integrated data, analytics and technology solutions to identify their highest risk/highest need patients and populations for targeted interventions. They also need simpler plan structure so that they can more effectively support the benefit coverage. Payers can provide the analytics to enable these collaborative relationships and drive decisions based on factual information… ultimately reducing total costs.
We also recommend looking at the full spectrum of an individual’s historical and current data to create a “whole person” view. This insight enables a payer to tailor care services in a personalized way that enhances engagement and helps lower cost of care. Through the use of data analytics, health plans can identify and provide appropriate outreach programs and alternative care services to best serve their members.
20 / 20 dashboard vision
Increasingly, payers are making sure their critical performance indicators include both medical and administrative costs with a common line of sight for all stakeholders. The goal is to develop one universal dashboard that bridges siloes across a payer’s business units and also encompasses the provider/payer partnership.
Beyond a universal dashboard, payers need to be confident that they have the business practices, policies and connections across their health plan to act on the business intelligence based on their strategic goals. It’s not enough to have the analytics. You also need to know how to apply it effectively because improvements in one area can make problems for others… creating more havoc than help.
Your path to a modern heath plan
Consider these three questions to gauge your next steps toward a modern health plan that reduces total cost of ownership:
- What will it take for you to have the intelligent and integrated data analytics you need to understand if you are performing well?
- How can you make sure the information is structured so that it is available to all aspects of the business to help you manage population health?
- When sourcing externally, which vendor is best able to deliver the technology to drive comprehensive business intelligence insights based on your business strategy?
Optum partners with payers like you to modernize your health plan and deliver the business intelligence that unlocks your ideal cost-saving value drivers. Learn more in this blog series and the resources below.
Read the Everest White Paper
Addressing Payer Costs through a Comprehensive Model: A Blueprint for Achieving Breakthrough Cost Savings
Watch Jimit Arora, Partner, Everest Group
Identifying the Most Optimal Sourcing Model from a TCO Perspective
View the Everest Infographic
Payers Can Save Up to 7x More through a Comprehensive Model
Connect with Optum to modernize your health care ecosystem
Catch up now on the articles you’ve missed in our “Bending the Cost Curve with Comprehensive Sourcing” series:
About the Author:
Donna Holmes, Senior Vice President, Optum Advisory Services
Donna Holmes leads our business performance consulting practice at Optum. She brings more than 30 years of commitment to helping health plan clients transform themselves through measurable financial and performance improvements. Donna works with health plan organizations across the U.S. providing executive leadership in the areas of business and IT strategic planning, business performance optimization and organizational alignment driving higher performance of the people, processes and technologies within an organization. She has been a frequent guest speaker at industry events and conferences including key topics on HIPAA, health care reform, and health plans for the future.