Healthcare Insurance Analytics

Healthcare Insurance Analytics

Insurance in healthcare is widely sought after, and has a large user base across the world, thanks to its universal usability. Unfortunately, tasks and procedures can bog down a typical insurance agent in routine activities and can lead to a lack of connection between on-ground and strategic direction. Healthcare Insurance Analytics comes in to bridge this gap, differentiating the wheat from the chaff. Here’s what you should consider that analytics offers.

Enrolment Metrics

Enrollment Metrics

  • Member count trend.
  • Details of the highest selling plan and least sold plan.
  • Groups members preference by Demo, Geo, Age, and others.
  • Shows the trend of how satisfied the users are with their current plan.
  • Comparison with other providers.
  • Identifying the target group and helps in marketing strategy.

Read More...

Encounter Metrics

  • The encounter is a meeting point for provider, physician, and member.
  • Health plan success mostly depends on how the encounter was.
  • Providers rating also depend on the encounter.
  • Timeliness and Quality of the encounter will be measured against providers.
  • Member provider encounter ratio based on service type.

Read More...

Encounter Metrics
Claims Metrics

Claims Metrics

  • Core aspect if health care.
  • Involves all three stakeholders – Insurance provider, Physician, and member.
  • Claim count by type and status is an important KPI.
  • Turnaround time for the claim should be less.
  • Ties to Encounter, Payment, Member, and Provider.

Read More...

Payment Metrics

  • Healthcare financials deals with both AR and AP.
  • AR – Premium amount paid – Needs to be validated with the subscriber count.
  • AP – Deals with capitation amount and Claim payment.
  • Payments for each provider and through different means have to be monitored.
  • Reversals, adjustment, duplicate pay needs to be addressed.

Read More...

Payment Metrics
Fraud-Abuse prevention

Fraud/Abuse prevention

  • Health care organization has its own share of Fraud and Abuse incident.
  • Example of Fraud and Abuse - Duplicate claims, incorrect use of codes, suspicious activities by providers and members.
  • It is tough to identify the fraud or abuse in health care and analytics will come to rescue.
  • Trends of claims by provider against procedure code and member.
  • The trend of member insurance usage.

Read More...

Utilization Management

  • Utilization Management deals with the member’s plan utilization and relevant approvals.
  • UM works with the provider to authorize any care that has been given to members.
  • Later it will be tied to claims for processing.
  • Encounter, UM, Claim will go into hands.
  • Trends of Authorization by type will help us to identify the number of UM analyst required.

Read More...

Authorization Count
Care Management

Care Management

  • Care management helps members stay healthier.
  • Engages in giving back to society.
  • Provides direction to members to mitigate their risks and lead a healthy life.
  • The goal is to reduce the insurance spending and thereby reducing the plan costs.

Read More...

Provider Management

  • Providers are the most important stakeholders in the health insurance domain.
  • Execute insurance delivery and provide competitive offerings to users.
  • Negotiation new contracts, extending existing contracts and identifying fraudulent providers is the key aspect of Health Care industry.

Read More...

Total-number-of-providers

New Call-to-action