How Claims Data Analysis Can Help Payers Outpace Market Competition 

Key analysis from a LexisNexis Risk Solutions and Healthcare Dive survey of payer professionals.

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In the healthcare industry, where competition is tight, having access to detailed market intelligence on individual providers as well as healthcare delivery organizations is critical to maintaining an advantage over competitors. Since the healthcare market is a highly competitive space, health plans need to be able to make informed decisions about entering new markets, designing new products, negotiating contracts and identifying potential fraud, waste and abuse. Claims data provides invaluable insights on the medical practitioners and facilities that are providing and influencing care in the markets relevant to your networks.

LexisNexis Risk Solutions, in partnership with Healthcare Dive's studioID, surveyed 107 payer professionals in primarily senior management positions to find out what types of market intelligence they claims data analysishave access to and regularly use for real-world strategy to stay ahead of the competition. 

Without access to market structure data and analytics that show the payer makeup of each provider, it's difficult for health plans to understand whether they have the right providers for their patients. And it's also challenging to know who the high-value physicians and facilities are so that payers can contract with them and know what sort of volume to expect from an acquisition or expansion. Detailed market intelligence derived from claims data analytics that depicts the real-world relationships of providers is invaluable to helping you understand how to effectively move your healthcare business ahead of the industry competition.

As the market trends continually shift and evolve, analysis of de-identified medical claims data provides key information on competitor transactions that can support a data-driven strategy for industry growth, recruitment and contract negotiation. In this way, you can see the contracted rates of your competition and compare your rates to the overall market. You can discover where you over- and underpay, and more.

All health plans can conduct analysis of their own network medical claims data and other market data as well as activity data, which are their key sources of insight on their own patient population. Additionally, hospital price transparency makes it easier to research what rates their providers are pricing their services at. But to complete the analysis, there are many other available metrics that must be pulled in from additional data sources for comprehensive market intelligence. Health plans that have access to these analytics insights will be more competitive in their long-term market strategies. And understanding competitors will enable them to make decisions on target with the needs of their customer population. Health plans lacking this in-depth market intelligence will be working from an incomplete picture, making it difficult to know if their decisions are on target with the needs of their patient population.

In a market this tough, a health plan can't afford to overlook any opportunity for a competitive advantage because access to actionable market intelligence is crucial to engage consumers and outpace the competition. Download the playbook to see what types of internal and external claims data and market research your competition has access to and how analyzing it allows them to make strategic marketing and business decisions.

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