Originally published by Avalere
Health Plans 2030
This insight, the third in a health plan strategy-focused series Health Plans 2030, details Avalere’s analyses on how the health insurance market will shift over the next five years and what plans should consider preparing for now. The first two installments on clinical care delivery and evolving operational approaches provide insightful background. To receive updates in this series directly in your inbox, complete the form below.
This insight was developed in collaboration with Tenasol. Tenasol provides artificial intelligence (AI)-powered technology solutions to health plans to make it easier to process large amounts of complex data and incorporate it into operational workflows.
How advancements in data and technology will impact health plan operations
Currently, many plans collect data from disparate sources and leverage a variety of platforms across the enterprise to serve discrete purposes. While this approach has generally served plans well up to now, it also generates a high degree of technical debt, risk of data leakage, and potential compliance concerns. As a result, plans are not tapping into the full potential of their capabilities to drive business efficiencies and are missing opportunities to improve quality of care and health outcomes for their members. To maximize the data and technologies available, plans will need to become more refined and nimbler with enterprise-level data strategies and platforms, harmonizing data from various sources to support disparate use cases across the business.
Current data sources will expand and there will be more data sources available to tap into going forward. Signs indicate that plans have begun to catch up to the rapid growth of data and technology, and in the future, will be even better equipped as they leverage knowledge and technology.
Figure 1. Expanding and Novel Data Sources
Further, technologies that currently exist will continue to develop in sophistication and adoption.
Figure 2. Examples of Technologies
Use of these technologies and data will evolve from providing efficiencies in current processes to identifying new opportunities such as identifying new ways of serving members’ needs, and/or anticipating new needs members may have even before they arise.
However, the existence of the data and technology alone is not sufficient to unlock its potential and maximize its use. Technology will continue to outpace regulation. Health plans should demonstrate responsible use and collaborate with healthcare stakeholders and policymakers to shape regulations for the advancement of shared interests and better member care. As plans’ use of data evolves, it will be necessary to find ways to harmonize data from various sources and leverage technologies that reduce administrative burden and enhance member care. To ensure trust from members, providers, and policymakers, it is critical for plans to harness AI in a way that supports—rather than replaces—stakeholders’ expertise and function.
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