Healthcare payer analytics assesses data about payers’ operations, health plans, and claims to derive insights into prevailing healthcare patterns. The insights derived from analyzing payer data help insurance companies adapt existing health plans, allowing provider organizations to modify their approach to offering medical services. In other words, using healthcare payer analytics solutions helps senior healthcare administrators make informed business decisions that increase revenues and benefit all stakeholders without any extra hassle.
Payers and providers often have disagreements over claims and reimbursements. One of the reasons for that is when payers disagree with doctors' decisions regarding the necessity of specific treatments or tests. As a result, payers may end up paying more than is medically necessary, or providers might recommend treatments not covered by payers. OSP can develop payer analytics solutions to help prevent these problems and indirectly improve revenues for payers.
A lot of Americans are reported to be underinsured. Many health plans lack coverage for people who are then denied necessary treatment. But OSP can build healthcare payer software to enable insurance companies to assess existing and historical data from payer operations and better develop health plans that cater to patient needs. In doing so, patients can avail themselves of the necessary treatments, and the providers can be reimbursed for the care they provide.
There is a wide range of reasons why members might drop out of plans. These include lack of coverage for some services, lack of covered pharmacies nearby, delays in care, etc. But OSP's custom solutions for healthcare payer analytics would enable insurance companies to assess all the operational data from health plans and obtain insights into what the patients need. This enables them to serve their members better.
We’ve reached out and found companies like OSP to create our technology. This is my first time working with a company that has been so thorough. These guys are amazing. If you really are looking for someone for a technology solution, these guys are the real deal.-- Stephen Carter
We reached out to OSP to provide an estimate on a technology solution we were interested in developing. From the initial conversation, the team was professional, courteous, and thorough. We were able to make a quick decision to move forward with OSP because we were confident that our requirements were accurately captured and the development deliverables and associated costs were clear.
The OSP development team stayed on schedule and within budget throughout the build phase and provided weekly communications to keep our team informed along the way. If we require application development in the future, OSP will be the first call we make.-- Selita Jansen
We have worked closely with OSP for two years, meeting twice a week to work through development requirements, strategy, design, progress, and support. OSP has become an integral part of our business, and our mutual teams work together as one team. OSP tackles problems that arise with integrity and operate with respect for budgeting.-- Charlie Langdon
Yes, I would certainly recommend their services because they were diligent and the offered price was very reasonable which is a challenge these days to get a great product at excellent pricing.-- Bert Lurch
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Healthcare payer analytics assesses the operational data about healthcare payer companies. This assessment considers insurance premiums, health plans, claims, reimbursements, and payments to identify useful patterns and obtain insights. These insights help payer companies to adjust their services accordingly. This could include modifying health plans to match patient needs, adjusting coverage according to provider services, optimizing adjudication processes to boost operational productivity, and so forth. In other words, healthcare payer analytics helps insurance companies serve their stakeholder better.
Payer healthcare analytics analyzes medical insurance companies’ operational data to reveal actionable insights. The data analyzed results from claims, reimbursements, premiums, denials, rejections, approvals, etc. Assessing this data reveals patterns that highlight the behavior of doctors and patients, which in turn can be used to make informed decisions about premiums and health plans.
The use of payer analytics solutions in healthcare involves data from several aspects of everyday operations at insurance payer companies. This can include claims adjudication, provider enrolment, credentialing workflows, out-of-pocket payments, and health plans. By assessing these processes, payers can identify the pain points and the causes of inefficiencies. Knowing this insight helps them to address the problems and boost the company’s efficiency and productivity.
Healthcare payer analytics also helps to minimize the approval of fraudulent claims and curb losses. Additionally, it enables payers to analyze providers’ services and alter their coverage of health plans accordingly. This would enable patients to get adequate care and help providers serve their patients.
Some examples of payers can include Medicare, Medicaid, and private health plan providers.
When patients see doctors at hospitals or clinics, they are provided consultations. The consultations may be followed by medication prescriptions, tests or scans, or all of them. These are called healthcare services, and the entities that provide them (doctors, hospitals, etc.) are called providers. A payer is an entity that pays for the services provided by providers.
Providers offer medical services to patients and send the bill over to payers through claims. The payers assess these claims to ensure that the services provided by providers are valid and necessary for the patient. If found to be valid, the provider claims are approved, and the providers are reimbursed. If there are problems with the claims, then they are rejected.
Providers are professionals who provide medical services like consultations, tests, treatments, procedures, scans, etc. Payers are entities that pay for the medical services provided by providers.
The spending on healthcare in the United States has reached a staggering $4 trillion. That is more than the economies of all but four countries. A very large portion of Americans has incurred sizeable healthcare debt. The spiraling costs of medical care are a major concern that policymakers have struggled to address.
Payers negotiate and set fixed prices for providers’ services with all the providers in the network. This means that when a person with a health plan visits a provider organization included in that health plan, he or she will be charged a fixed amount of money for medical services. Without health plans or coverage, the provider organization (hospital, clinic, practice) can charge an excessive amount for the same services. This is why payers are important in the United States healthcare system.
Some of the trends that are expected to shape the healthcare payer industry include the following –
Telehealth is one of the biggest trends in healthcare to watch out for. It aims to disseminate medical services remotely through digital and telecommunication technologies. However, some providers are skeptical about this as some payers don’t reimburse telehealth services in the same way as they do for in-person patient visits.
Artificial intelligence (AI) has been the hot buzzword in every industry. For healthcare payers, AI holds enormous promise in automating parts of processes like claims adjudication. Additionally, AI-powered algorithms can also be used to analyze large quantities of data to provide useful insights for boosting the productivity and efficiency of everyday operations.
The growing costs of care in the United States have prompted many policymakers to prioritize affordable care. In light of this, value-based care models have been growing in popularity as they enable more people to access the care they need. Entities like Accountable care organizations (ACOs) and Health Maintenance Organizations (HMOs) are gaining popularity. Payment methods like bundled payments are known to reduce the cost of a single episode of care.
Data analytics often uses historical data to forecast what will happen shortly. But with rapid changes afoot, payers would increasingly have to turn to real-time data to fuel their analytics solutions.
A good example of the importance of real-time data is the shift in memberships of health plans. As the world is bracing for a recession following the already crippling pandemic, there is a migration from employer-sponsored health plans to Medicare, Medicaid, and Affordable Care Act entities.
Payers can derive useful insights into health plans and reimbursements by assessing real-time employment data and subsequent coverage. This is perhaps one of the most prominent examples of using real-time data analytics for forecasting by payers.