Payers can use clinical data to identify gaps in care, alert providers, and optimize network performance, cost and profitability. When data has improved accuracy and consistency, payers can eliminate deficiencies, boost network performance, receive bigger incentive payments, and increase membership. Payers can also help providers make better care decisions by providing feedback, sharing metrics, evaluating performance against peers, and delivering automated alerts. Accurate claims adjudication is achieved through improved clinical data management, enhancing efficiency and satisfaction for providers and members.

2. Driving Enhancements in Payer Operations
A solid strategy for managing clinical data
offers providers a single, consistent, and
accurate view of member care outside their
practices. Payers can quickly identify gaps
in care and alert providers to promote better
outcomes.
This new relationship paradigm, however,
can only be successful if it is data-driven.
Let’s see some possible enhancements:

3. Cost and Profitability Optimization
When data has improved accuracy and
consistency, payers can:
• Eliminate deficiencies in information
• Boost network performance
• Receive bigger incentive payments
• Increase membership

4. Provider Partnership and Care Coordination
Payers can help providers make better
decisions at point of care when:
• Providing feedback
• Sharing cost and quality metrics
• Evaluating provider performance
against peers
• Delivering automated alerts

5. Claims Adjudication
Accurate claims adjudication is achieved
through improved management of clinical
data. Accelerated claims turnaround,
with fewer errors, enhances operational
efficiency, while boosting provider and
member satisfaction.
Optimize claims adjudication and promote
better care. Read more here.

6. Member Engagement
Members are engaged if:
• Payers can create incentive programs
that motivate lifestyle changes that lead
to an improvement in overall well-being
• Payers provide consumers with the
ability to interact with their own data
and receive information about their
healthcare services

7. More Value for Payers
For five more enhancements, and some
challenges to making data actionable,
read our new, updated white paper,
“Getting the most from your clinical data”.
It provides additional information on
solutions that can help support member-
centric strategies by harnessing data.