Scaling Smarter: How Leading Health Plans Use Data to Improve Outcomes and Control Costs

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Health plans looking to attract and retain members will need to offer flexible, competitive benefits and personalized, consumer-centric experiences across the care journey. At the same time, cost management is increasingly critical for maintaining profitability amid rising utilization and persistent inflation. Payers also need to satisfy regulators, who keep pushing for demonstrable improvements in care quality while incentivizing managed costs. As reimbursements are tied to quality measures such as Medicare Star ratings, payers must leverage data to identify and contract with the highest-performing providers. These issues will only become more pressing as the healthcare industry shifts toward value-based care (VBC), a move that’s well underway.

As the payer community scales up its ability to aggregate a patient’s longitudinal health record, the supply of generative AI and machine learning techniques offer payers accessible opportunities to guide beneficiaries through every step of their care journey, and to increase the productivity of member engagement, care management, and performance improvement activities.”