How analytics can help create more competitive health care networks

Read the full transcript here

Even before the COVID-19 pandemic, the health care market was shifting rapidly. Now health plans are in an even more complex and challenging space, and they must focus on modernizing their networks.  One of the key factors to that modernization is being able to dive deep into network analytics. 

“Those who are in the position to win the game are using advanced analytics,” says Elena White, VP of Optum Advisory Services. “They use those analytics to differentiate themselves from the market and to develop new strategies and initiatives.”

White recently joined Sam Stearns, VP of Product Strategy at Optum, for a webinar discussing the power of analytics in creating competitive health care networks The webinar covered some of the challenges health plans face in innovating today, and how analytics can help plans overcome those challenges. Stearns and White also provided real-world examples of how advanced analytics from Optum have helped payers modernize and outrank their competition.

Challenges in modernizing networks

As networks develop new ways to stand out in a competitive market, they often face internal and external challenges with modernization initiatives. The challenges can include:

  • Identifying high-performing providers and learning how to direct members to those providers
  • Encouraging physician engagement and what type of programs can successfully influence physician behavior
  • Eliminating low-value services
  • Addressing small-panel providers that may have significant membership in aggregate but individually have low membership

On top of these hurdles, COVID-19 is also slowing down the innovation process.

“When we surveyed health plans, COVID-19 is a big area where they’re facing challenges in running their day-to-day networks,” White says. The webinar covers a host of new operational, financial, actuarial and growth hurdles that the pandemic has created.

How analytics can help payers innovate

Although there are many challenges to the innovation process, payers can use advanced analytics to dive into data about their network. This helps them identify opportunities for programs that could improve financial performance.

“This process makes observations about the network from a qualitative and quantitative perspective to find gaps and design solutions based on those insights,” White says.

As an example, White and Stearns discussed how one health plan used analytics to develop five programs that optimized spend. With these five initiatives, the plan estimates savings of $17–$30 million in commercial services and $14–$21 million in Medicare services.

Use analytics for ongoing performance improvement

Taking advantage of your plan’s robust data is a critical step to saving money. It also creates a network that drives higher volume and revenue. Ultimately, it also means providing better care to patients.

And the analysis shouldn’t be a one-and-done task. It’s essential to create a process that allows you to continue to improve and optimize costs, Stearns says.

“Leading health plans are using analytics as a central component for a number of network initiatives. And the plans that do it well have a framework with ongoing innovation,” he adds. “This helps the plans continuously improve performance that results in access to high-quality and affordable care for their members while also helping them stay competitive in the market.”

To hear more about how advanced analytics help health networks innovate, watch a recap of the webinar: Creating Competitive Networks with Analytics. For questions or more information on Optum Performance Analytics, please contact Loren Koerber at loren.koerber@optum.com.


Leave a Reply