Health Insurance

Healthcare insurers balance the needs of many constituents to provide quality care while managing cost: Analytics help solve this complex equation

The recently passed Healthcare Reform Bill will bring sweeping changes in health insurance, adding millions of new customers but also strict underwriting regulations. Consumers will become more involved, with an increased exposure to cost sharing and a heightened sensitivity to price and quality of care. Insurers must keep pace with consumer demands, navigate shifting regulations, and innovate with providers to deliver quality care while managing cost.

A wealth of information is available to inform decisions. Claims data can be used to evaluate performance at the level of disease, provider, patient type or employer group. Advances such as e-prescribing and EHR are delivering ever more robust data.

Axtria enables managers to unlock the value of this data and improve decision making through the application of analytics to specific business issues facing health insurers. Examples include:

Understanding drivers of cost and utilization. An in-depth understanding of demand and cost of services is fundamental to designing plans and managing clinical risk. Analytics facilitates assessment by patient type, provider and procedure to uncover cost drivers and accurately evaluate financial performance

Evaluating employer group satisfaction and profitability. Understanding drivers of customers’ buying decisions can help manage retention and growth of high value accounts. Analytics solutions take into account each customer’s ‘value drivers’ to define a plan for the customer that delivers maximum value while achieving financial objectives