The role of big data and analytics in health payer transformation to consumer-centricity

Abstract

Historically, information management for payers has been focused on enabling efficient operations, such as claims administration and group management. Recently, with the rise of individual insurance and increasing pressure to reduce cost through better health management, healthcare payers are transforming its business to be increasingly consumer-centric. In the healthcare payer setting, consumercentricity means to put individual consumer at the focus of payer operations. It is to understand and engage individual consumer throughout the insurance lifecycle, from assisting prospects to choose the most suitable product, engaging new enrollees in wellness, to assisting members navigate the healthcare system. In this chapter, we discuss the implications of consumer-centricity and external data explosion on payer information management, ranging from data management, analytics applications and use cases, to the analytics delivery platform. We also discuss how consumer data and open data support this transformation, shedding insights into range of business processes, and expanding the role of informatics in the payer organization.