The shift from fee-for-service to value-based care (VBC) payment models requires data that delivers contextualized, longitudinal member views for payers to quickly identify care gaps. However, payers and their data leaders often face a patchwork of siloed systems when addressing population health. Commonly, claims, clinical data, pharmacy, social determinants of health (SDoH), and behavioral health data are housed separately.
When surveying the industry, Gartner found that complex data ecosystems not only lead to bad decision making but that poor data quality also costs the healthcare industry $12.9 million annually. Data consolidation is no longer only an IT goal, it’s a strategic imperative for payers to reduce avoidable utilization and improve medical loss ratio, outcomes, manage risk, and power VBC operations.
Payers should prioritize efforts to create a centralized and actionable data environment that contextualizes data, making it accessible, accurate, and useful to reduce inefficiencies and support faster member engagement/campaign deployment.
Why Disparate Data Undermines VBC Performance
Data leaders know that fragmented, siloed data leads to incomplete member insights that negatively impact care, downstream outreach and balloon medical spend. They are continually up against these challenges when trying to sift through the member data to uncover care gaps, duplication, and delayed interventions. These pain points lead to internal operational inefficiency as data analysts spend their time cleaning and reconciling rather than analyzing member insights.
Externally, the downstream impact affects both members and providers. Member experience suffers as disconnected data means disjointed care coordination and missed engagement opportunities, which can impact quality scores like HEDIS and Star Ratings. Payer-to-provider relationships can also strain since inconsistent data feeds and unclear performance measures weaken trust, further preventing payers and providers from hitting VBC benchmarks.
In addition to fragmentation issues, health plans often find data to be riddled with quality issues, unresolved identities, incomplete care journeys, missing feedback loops, and lacking visibility into the member’s health status. What makes health data so challenging is that it’s not only scattered across electronic health records, claims systems, call centers, web interactions, third-party apps, but each source may use different formats, identifiers, and update cycles – making it difficult to unify, interpret, and act on the data in real time.
However, by approaching data consolidation with data readiness best practices, payers obtain a deeper understanding of their members. The process enables access to contextualized member insight for situational awareness and behavioral signals that reflect where a member is on their care journey. Payers can personalize, predict, or optimize engagement based on the whole-member health story. Because payers understand members at personal levels, they are better equipped to use the data to fuel meaningful engagement. This outreach activates members to close open care gaps, which ultimately bolster VBC performance.
Limitations of Existing Solutions
To consolidate data, a focus on data readiness can help fill the data fragmentation gaps that can arise from varying technology and workflow processes. Data readiness takes “dirty” data from disparate sources and makes it clean, accurate, and fit for purpose.
A common misconception is that data readiness can be addressed by using systems such as Master Data Management (MDM), Customer Data Platforms (CDPs), or data clouds; however, these systems have several flaws. First, they miss the dynamic aspects of member behavior, second, they may have flaws in aggregating and unifying upstream data, and thirdly, they don’t solve for identity or data quality. Without correcting the upstream data quality issues other platforms fail to address, health plans are not solving the core issues.
Data readiness prepares member data to power any initiative across the enterprise. It delivers the most accurate and complete member record with data that is cleaned, enriched, and unified. With a strong data readiness foundation, health plans can then turn information into impact across the entire member journey with complete, accurate, timely, actionable, trusted, and compliant data.
Data Readiness is a Strategic Enabler
To accelerate innovation and competitive differentiation, data readiness must be prioritized. With fit-for-purpose data, member identities are resolved across technology systems, behavioral and transactional signals integrated, and longitudinal insights accessible in real time. Health plans can then rapidly launch new products, deploy engagement campaigns, personalize member experiences, and partner more effectively across the ecosystem. In this way, data readiness is not just a technical requirement, it is a strategic capability that enables plans to adapt, compete, and lead in a consumer-driven healthcare market.
Redpoint achieves data readiness for payers through its Data Readiness Hub, which includes:
- Automated data quality: Standardization and error correction that happen continuously and automatically, preventing errors from compounding downstream, keeping analytics and engagement tools running smoothly.
- Advanced Identity Resolution: Deterministic (exact match) and probabilistic (likelihood-based match) techniques to fit specific use cases. It also understands data from anonymous-to-known journeys, enables a longitudinal view of each patient, and the ability to group individuals who share a household or financial relationship.
- Contextual Profile Unification: Curate customer data into clear and actionable profiles — validated contact information, meaningful clinical and behavioral signals, and key interactions across the care journey. Patient profiles are automatically enriched with AI models, calculations, and trusted third-party data to communicate with speed, accuracy, and empathy.
- Smart Activation: Where clean, connected, and contextual patient data becomes a strategic asset. Dynamic, real-time segments evolve as new data flows in, continuously orchestrated across multiple engagement channels—whether digital or physical—ensuring that every interaction is timely, relevant, and personalized.
The ROI of Data Consolidation
With Redpoint’s Data Readiness Hub in place, data is fit for purpose. Payers can turn data consolidation into a competitive advantage to achieve the most important goal of VBC operations: improved clinical outcomes.
Redpoint serves as the connective tissue between technology systems. The Data Readiness Hub enables teams to centralize data from multiple tools, conduct usage audits, and eliminate redundant platforms while preserving core functionality through flexible orchestration and data continuity. Redpoint also creates a centralized, actionable data environment, enabling payers to make member data accurate, accessible and useful to reduce inefficiencies and support faster member campaign deployment.
Data leaders can use the contextualized data to fuel population health strategy to ensure the organization can deliver personalized, effective engagement to close open gaps in care, better manage those with chronic disease, reduce hospital readmissions, and bolster member experience to secure VBC reimbursement. Data consolidation is about empowering payers to fulfill the promise of VBC. Payers who unify and contextualize their data gain a critical edge in improving member outcomes, strengthening provider networks, and driving operational efficiency.
Interested in learning more? Check out Redpoint’s data readiness hub for payers: https://www.redpointglobal.com/healthcare-payers/
