How Healthcare Payers and Providers Can Harness Big Data for Big Results

Todd Hinton | April 17, 2018

The rise of big data has impacted everything, but healthcare payers and providers have felt a stronger impact than many others. The reason is that healthcare as an industry has always strongly emphasized data – from claims information to medical records – in their decision-making about patients. What has changed now though is that patients have started to demand greater transparency in their insurance and healthcare decisions. These consumer demands create market pressures where they didn’t exist before, largely because most customers bought health insurance through their employer and visited doctors based on who was in or out of network.

Then retailers started offering personalized interactions within e-commerce portals. And consumers began to expect the same kinds of individualized experiences that retailers provide with other brands, including those in healthcare and financial services. There is substantial ROI to be had from healthcare payers and providers personalizing their interactions with consumers. A recent Boston Consulting Group study found that personalization will push a revenue shift of some $800 billion over the next five years in retail, healthcare, and financial services to the 15 percent of companies that get it right.

How can healthcare payers and providers tap into this revenue potential? The simple answer, of course, is to more effectively harness their big data.

The Power of Big Data in Healthcare

Healthcare payers and providers have always been data-driven organizations. For healthcare payers, this includes claims information and demographic information about their plan members. For healthcare providers, this includes medical histories and treatment plans for their patients. Historically, the data healthcare payers and providers store has been stored in centrally controlled data warehouses. It was only accessible for modeling by requesting assistance from IT – which took too long for it to be used in anything but the most general campaigns.

All the data stored in those systems is a treasure trove of insight into patient behavior and preferences. Healthcare payers and providers that leverage the customer data they’re collecting anyway can improve health outcomes and enhance engagement in the same stroke. The best part is that customers want to receive the kind of communication that healthcare payers can deliver. Nuance Communications recently found that 69 percent of consumers are interested in receiving proactive reminders regarding their current health plan or relevant offers.

Healthcare providers can enhance health outcomes through the power of big data through a combination of trend analysis and making better treatment decisions with access to historical information. Leveraging a big data solution to manage patient medical information can also cut down on duplicate records, which cost health systems an average of $96 per record to manage. Compounding the problem is that repeated tests or delayed treatments caused by duplicate records increases costs by $1,100 per patient, and more than 100,00 people die every year because of mistaken identity or “wrong patient” errors.

Looking at the benefits of effective big data management holistically, it’s clear that healthcare payers and providers have a lot to gain from leveraging their data effectively. Healthcare payers can offer a more nuanced relationship with plan members, and healthcare providers can make better care decisions – all through maintaining and leveraging their big data.

Unify Siloed Big Data for Better Customer Engagement

Among the major barriers facing better customer/patient engagement in healthcare is the lack of unified data across siloed systems. Healthcare payers and providers have historically lagged other consumer-facing industries by about a decade in technology adoption, which is why they retain siloed systems while many other companies have shed them. To maximize their customer engagement, healthcare payers and providers need to overcome two challenges: historically risk-averse cultures and extensive regulations about patient privacy.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 added extensive teeth around preserving patient privacy, which is why many healthcare organizations may be reticent to leverage their patient or plan member information in their marketing efforts. HIPAA has even complicated adopting electronic medical records at many healthcare provider offices, which makes the cost of care even higher from maintaining proper records.

It is still possible though for healthcare big data to be leveraged in engagement marketing, even with HIPAA regulations in place. Marketers at healthcare providers can leverage personally identifiable information for appointment reminders, for example, and can anonymize more detailed diagnosis information to be used in providing better care more generally.

Marketers at healthcare payers can leverage data for proactive health reminders, such as flu shots and tips for cold season, as well as educating members on their plans. According to Competiscan, only 35 percent of healthcare plan members fully understand their plan benefits, and only 25 percent of members fully understand the wellness and disease management programs that come with their plan.

Healthcare organizations need to implement a centralizing solution for their big data so they can leverage the information that is possible to use in campaigns where it is necessary. For that reason, big data needs to be made accessible across silos, but with strict data governance rules to ensure that only the people who need access to the data can access it. This is possible with several flexible solutions, including a customer data platform, which unifies data across functional silos and makes it accessible (with appropriate controls) throughout the enterprise.

Emphasize the Customer Experience

Unifying data across silos isn’t enough if healthcare payers and providers aren’t thinking like their customer. It has fast become apparent, with the changing healthcare marketplace, that competing based on what services are offered isn’t enough anymore. Consumers have become laser-focused on price, and have started to move away from the opaque models of traditional healthcare payers and providers to brands that offer greater price and benefits transparency.

Cost pressures in the marketplace from legislative reform, the overall economic climate, and payment innovation require new methods and new systems to compete. Therefore, healthcare payers and providers need to emphasize the customer experience – across the digital and physical realms. According to IntelliResponse, 58 percent of consumers would consider switching their health insurance if they had a poor online customer service experience.

Consumers don’t stop looking for the best deal when they become patients, and healthcare is no longer a “black box” where payers and providers hold a dominant position. As patients become more focused on choice and discerning in their experiences, healthcare payers and providers need to leverage the data they’ve collected over a period of years, unify it across silos, and integrate it into their patient engagement methodologies to succeed in the long term. Because if they don’t, then other brands certainly will.

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Todd Hinton
Todd Hinton

As VP of Engineering, Data Management for RedPoint Global, Todd Hinton leverages more than 20 years of technology management and software development experience to his oversight of RedPoint Global’s data management product offerings, including master data management and the RedPoint Customer Data Platform. Connect with Todd on LinkedIn and Twitter.