Drive Member Health Insight Beyond Claims Data

Using Data to Drive Member Health Insight Beyond Claims Information

There is much more to each member than their claims data and history. Tailoring your message and healthcare offerings is about seeing each member as more than a diagnosis or billing code.

There is much more to each member than their claims data and history. Tailoring your message and healthcare offerings is about seeing each member as more than a diagnosis or billing code. Instead, they are someone with unique needs based on their geographic location, financial situation, individual healthcare challenges, and more.  

As a payer, you receive information about a member each time their healthcare provider submits a claim. But that is often a limited snapshot into the individual, especially when data is incomplete, missing or inaccurate. Some populations may be especially vulnerable to incomplete records. Members with lower access to care, for example, might become a casualty of the inequalities perpetuated by incomplete healthcare data. Not knowing the whole picture for a member prevents payers from offering support that is relevant and timely.  

The LexisNexis® Risk Solutions e-book, “Plans improve member care with better data,” explains the vital role comprehensive data can play in creating a whole picture of each member’s health and wellbeing.  

The e-book uses the example of Dave, a man limited by joint pain, to illustrate how payers can optimize a member’s health outcomes through data. Like many members, pain is what drove Dave to seek medical care. But the provider noticed Dave as a whole person, one who had gained weight since the last visit. In fact, the extra weight was likely worsening the pain on his joints.  

If the provider hadn’t submitted a claim for anti-inflammatory medication and/or physical therapy to treat joint pain, you as a payer may not realize that Dave has obesity as well. And because obesity can place a member at risk for a whole range of related conditions – such as heart disease, diabetes and some forms of cancer – you also wouldn’t know to recommend tools to help Dave manage his weight and potentially prevent these serious outcomes.  

Having more complete and updated information can help you help your members lead healthier lives. Even when a member is new and has little or no claims data, payers can work on getting more data to build a complete picture of the individual in the meantime.  

Updated information can include something as straightforward as each member’s contact information. People move, change jobs and move to new health plans. But that’s not an excuse for keeping inaccurate contact information on file, especially when a payer notices a member is no longer filling a prescription or showing up to physical therapy sessions. And it’s nearly impossible to provide preventive care and education to each member without an reliable way to reach them, by phone, text or mail, for example.  

And what about members who don’t go to the doctor for regular checkups or until a condition is more advanced and therefore more difficult to treat? It may not be their fault – some people have jobs that make it difficult to take time off to see a doctor. They may not have reliable transportation or are worried about copays, deductibles and out of pocket expenses. The LexisNexis® Risk Solutions e-book also offers strategies on how to identify those members and meet their needs. And you guessed it – it’s through more whole person, comprehensive data.  

Find out, for example, how social determinants of health (SDOH) data can illuminate the challenges people face in accessing equitable healthcare services. In the absence of claims data, SDOH information can inform a payer about everyday challenges like transportation and food insecurity that factor into health and wellbeing. That kind of insight helps you target these members with critical information on how to manage the real hurdles they face day-to-day – so they can better prioritize their own health.  

  To learn more, download the LexisNexis® Risk Solutions eBook:

Plans Improve Member Care with Better Data