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Apr 2015 - Best Practices - Doc # HI255279

Best Practices: Payer Analytics for a Post-Reform Market

Author: Deanne Kasim

Abstract

This IDC Health Insights report enables payer analytics vendors and payer decision makers to understand the current and emerging issues related to today's executive and individual department users' information and reporting needs. This report also provides a discussion of the need for improved interoperability standards and frameworks to better enable the future integration of clinical and financial information between payer and provider applications.

Evolving reimbursement structures, exponentially growing amounts of data from clinical and financial sources, an increased focus on consumer engagement, and a developing population health approach to disease management are driving the transformation of payer analytics solutions. The U.S. CMS continues to drive much of the need for enterprise-level analytical reports through its continuing regulations and emphasis on new pay for performance (P4P) and other value-based reimbursement (VBR) approaches.

"While today's payer analytics applications provide a comprehensive set of executive-level and individual line-of-business reporting capabilities, there is room for future improvement in terms of the potential for better big data management and the integration of clinical, financial, wearable, remote, and other important sources of healthcare data. Industry- and federal government-sponsored progress on the future development of interoperability standards can be expected to improve payer analytic solution capabilities and decision support." — Deanne Primozic Kasim, research director, Payer Health IT Strategies

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