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Healthcare Payers

Advanced healthcare payer analytics for improved care

Healthcare payer analytics solutions analyze a payer’s operations, claims data, and health plans to collect valuable insights from population health patterns.

Health insurance agencies and providers rely on this trusted data source to adjust health plans and services, which opens the door for mutual economic success under Medicare, Medicaid, and commercial risk-based contracts.

Ready to put healthcare payer analytics solutions to work?

The challenge

Healthcare is changing, creating new challenges for growth

Emerging competitors, changing member expectations, and stricter regulations are making it more difficult to succeed. Lack of time among stakeholders is also hindering effective communication between clinicians, payers, and members.

In addition, as the healthcare industry steps into value-based care, access to reliable cost and quality monitoring systems is a must. Care managers are up against the clock to make timely decisions for at-risk populations to receive relevant and appropriate care.

The solution

Improve your healthcare payer analytics strategy to retain members and reduce costs

A data-driven strategy promotes collaboration, cost efficiency, and support for value-based care. Deliver personalized experiences, reduce administrative efforts, and create new health and wellness benefits for members, employers, and providers.

Payer analytics advantages

Break through data silos

Transform disparate information into a longitudinal view of patients through clinical and claims data. Integrate claims data, clinical records, and external sources into one accessible source for enhanced care coordination.

Close gaps in real-time

Help providers make impactful decisions at the point of care with insights delivered at just the right time. Surface gaps and take immediate, informed action before they escalate cost or decrease care quality.

Act on what matters most

Stop the data debates and allow your teams to focus on the best next step. Form a unified, data-backed consensus that allocates resources and interventions to where they are needed most.

Drive innovation

Unlock collaboration across your organization, providers, partners, and members. Tap into advanced machine-learning analytics to track new insights and trends that identify and strengthen areas of improvement.

Automate manual workflows

Forget spreadsheets and unify business processes and infrastructure on a single source of truth. Streamline claims processing, utilization review, and care management workflows through automation to avoid manual errors and accelerate decision-making.

Scale your business

Spot opportunities and problems quicker with an intelligent analytics platform built for payers. Scale your business with confidence knowing that increased numbers of members, providers, and data sources will not slow operational efficiency.

5 Types of Healthcare Payer Analytics

Provider analytics

Provider performance data, such as cost efficiency and clinical outcomes, offers key insights into the effectiveness of providers’ practices. Monitor and assess performance using Arcadia’s healthcare payer analytics solution to inform improvements to care.

Population health analytics

Quality of care, health indicators, and other data points can guide targeted interventions through healthcare payer data analytics. Identify health trends and disparities with a comprehensive view of population health data.

Claims analytics

Understand the patient experience by analyzing healthcare utilization, costs, and effectiveness of care through claims data. Payers can manage costs using payer analytics solutions to identify health demands and allocate resources accordingly.

Risk adjustment analytics

Healthcare payer analytics helps payers assess healthcare payments and allocate resources fairly using the health risk profile of individuals or entire populations. This enhances equitable financial arrangement and reimbursement for healthcare services.

Reporting analytics

Healthcare payer analytics empowers collaboration and information sharing by enabling users to leverage interactive reports and filtered views to access meaningful insights into their data. Use reporting analytics to optimize data presentation for actionable takeaways.

Close large risk and care gaps with Arcadia’s healthcare payer analytics solutions.
Clinical data

Unlock the benefits of clinical data for risk and quality

Use Arcadia’s healthcare payer reporting platform to discover actionable insights and distribute highly-personalized and contract-specific reports to providers, employer groups, and more–at scale.

4% lift in risk

When you supplement claims data with clinical vs. claims only data

.04 more RAF

Captured through supplemental EHR documentation

~.3 higher Star Ratings points

Captured by supplementing your claims data with clinical data

Data integration

Centralize data management for real-time data exchange

Power your business with a provider source of truth. Integrate your business for coordinated and collaborative innovation by unifying your infrastructure and associated business processes with a service oriented, centralized platform.

Operational enablement

Drive operational efficiency with new workflow tools

Empower providers with collaborative tools to drive better outcomes, and increase provider performance by connecting data from various sources.

Read this section to learn how Arcadia's healthcare payer analytics solutions power better outcomes.

Close more risk, drive better performance

A northwest payer saw a $7M increase in their Medicaid premium by partnering with Arcadia to improve their closed risk per patient by 59%. Based on a comparison of the open risk documented with and without using Arcadia for pre-visit planning and at the point of care.

Latest Resources

How we're making a difference for our customers


We chose Arcadia because their product seemed to be the best balance of newer architecture and technology with rich, real-world functionality that was strong in general purpose analytics, data science, perspective health status assessment, and quality management. And Arcadia had really outstanding leadership in terms of the knowledge of the business. We were very impressed with the people, and we have continued to be able to have access to those people, so that was a big part of our decision as well.

CEO/President, SEPTEMBER 2022

A data analytics platform for healthcare payers

Support provider performance, make care and risk gaps actionable, combine clinically integrated data with predictive analytics, and improve ROI for your risk adjustment programs.