7 ways payers use patient data

Health plans use patient data seven different ways, according to a report by Avalere and the National Pharmaceutical Council.

The report, titled Health Plan Use of Patient Data: From the Routine to the Transformational, provides a framework for the way health plans are using information from administrative claims, EHRs and mHealth devices to improve care. Avalere and NPC developed the report based on interviews with health plan executives and other relevant stakeholders.

Here are the seven use cases, listed from the most simple to the most advanced, as outlined in the report.

1. Utilization management to direct resources appropriately and efficiently

2. Treatment and medication adherence to improve quality and reduce costs

3. Network design to build provider networks with higher quality and lower costs

4. Population health management to improve care coordination and outcomes

5. Clinical pathway development and design to standardize patient care

6. Predictive analytics to anticipate individual and population care needs

7. Value-based contracting to align financial incentives with quality and cost outcomes

Click here to view the full report.

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