Health Insurers are Increasingly Reliant on Clinical Analytics

Health insurers today face monumental changes in the way they use information technology. While they once relied on IT mainly to automate claims processing and crunch numbers for actuarial tables, they increasingly turn to the same kinds of clinical information systems used by hospitals to review diagnoses and treatments to monitor their costs and appropriateness. Much of this change came about as a result of the Patient Protection and Affordable Care Act (PPACA).

As the health care industry shifts to new payment models that pay for outcomes rather than for volume of services, health insurers are investing in clinical analytics. They are using that data to assess patient outcomes, and to determine best practices in terms of interacting with patients to improve health. Since they will no longer be able to reject consumers with pre-existing conditions, they’re shifting their focus to health outcomes in the insured population as a means of managing risk. For example, health insurers are now using hard data to drive initiatives with goals like preventing hospital readmissions, managing chronic diseases like diabetes more effectively, and tracking medication compliance.

In this way, the goals of health care providers and health care insurers have become more closely aligned: to collect and leverage clinical data in ways that can enhance care delivery, manage costs, maximize patient safety, and ultimately improve the health of a whole population.

However, health insurers face challenges as they make the move to clinical analytics. As an IT professional with a health care informatics degree, you can assist health care payers in their mission to analyze data to generate insights. Currently, specific challenges include:

  • Data input. Unfortunately, some clinical data (e.g. handwritten physician notes) still exists on paper. Additionally, electronic data comes from many sources (pharmacies, medical labs, etc.) and may be housed in databases that aren’t connected or compatible. Informaticists understand this fact and can use tools to get all relevant data into the system.
  • Data mapping. Once data is in the system, it must be mapped for extraction if it is to be available for analytics. This mapping is particularly challenging when data is not captured in discrete data elements, as it may have to be converted through an intermediate process. Informaticists know how to perform these conversions.
  • Incomplete data. When records are incomplete, data elements required for an accurate analysis may be missing. An informaticist must identify missing elements, know where to find them, and acquire the data necessary to present a complete and accurate report.
  • Data insights. Raw data alone is often of little use. Informaticists can assist in translating raw data into business intelligence that an insurer can act on.

American Sentinel’s online health informatics degree, the Master of Health Care Informatics (MHCI), offers a degree designed to provide skills in gathering, analyzing, and presenting health care data for clinical use.