Category: Healthcare Analytics

Health insurance companies generate the bulk of their profits by charging premiums to policyholders, or members, and then investing those premiums into interest-earning assets. But to increase the amount available for investment, insurers need to work hard to deliver good service that makes policyholders happy while keeping their operating costs in check. Key performance indicators (KPIs) allow health insurers to track both.   What are Health Insurance KPIs?   Health insurance companies deliver health insurance plans to individuals, businesses, and groups, including enrolling members, processing claims, managing accounts, and providing…

When healthcare providers submit medical claims for reimbursement, they expect the insurer to pay claims quickly and accurately with no or minimal back and forth. If the process is unwieldy—even if the provider did not include the correct claim information—both the insurer and the provider lose. For reasons like this, it's important to track health insurance claims with performance metrics. How Tracking Health Insurance Claims Can Improve Performance   After a patient receives care, doctors, pharmacists, physical therapists, and other healthcare providers submit a medical claim to a health insurance…

The cost of healthcare continues to outpace inflation. The Centers for Medicare & Medicaid Services (CMS) predicts that U.S. healthcare spending will reach nearly $6 trillion by 2027, accounting for 19.4% of GDP. All stakeholders in the healthcare ecosystem—including health insurance companies--are facing increased pressure to reduce health care costs. Benchmarking is one tool that health insurance companies can use to measure their operational efficiency and identify areas to lower costs. What is Health Insurance Benchmarking? The health insurance industry is highly regulated. For example, the Affordable Care Act (ACA)…

What is healthcare analytics? Healthcare analytics is defined as quantitative and qualitative processes that are used to enhance healthcare productivity through desktop, server or cloud-based applications that store and categorize data to draw conclusions through the patterns that emerge. The data analyzed can be historical, old records already in the company, or new information that is being processed from internal or external sources. Using data analysis within the healthcare industry can increase revenue, improve efficiency within the business, optimize customer service, and plan ahead to outpace competitors in the marketplace.…