Health plan data analytics

Manage costs & health outcomes across member populations

Health plans are under pressure to enhance members’ healthcare experience, quality and outcomes — and do it all at a lower cost. To succeed, you need more than just reports. You need the confidence to make informed decisions. You need new, richer perspectives.

HDMS can help you explore your data in fresh ways to maintain a competitive edge.

Our health plan data analytics solution is able to transform data — in any format — to deliver a clear path to business success. We integrate data from numerous disparate sources, including traditional sources (such as medical, eligibility and pharmacy) and non-traditional sources (such as wellness programs, disease or care management programs, biometrics, wearables, provider and lab data). You get a more complete picture at the member level, as well as at the overall plan or program performance levels.

With our powerful analytics tools, decades of experience and flexible approach, we can help you generate both high-level insights and detailed views to:

  • Enable more informed decisions
  • Measure & manage risk
  • Identify cost-saving opportunities
  • Evaluate performance
  • Improve care quality & patient outcomes

"We're able to provide [our clients] direct access to all of their data, and a way to view it as a story as opposed to just a series of reports."

– Shawn Shapiro,

Director of Client Analytics at Meritain Health

Health plan data analytics for a wide variety of markets

Challenges facing commercial plans

As a commercial health plan, you must maintain market competitiveness and optimize provider networks even as you navigate the transition to value-based care. That means figuring out how to improve members' outcomes, care quality and experience while driving down the total cost of care across varied populations. You need actionable insights.

How HDMS helps

Our experience working with commercial plans in a variety of distinct markets across the U.S. gives us an exceptional understanding of the data and insights you need to gain a competitive edge.

Case study

Discover how we helped one large Southeastern health plan determine utilization and medical costs for members participating in their health management programs.

Challenges facing federal plans

It's tough to keep pace with all the federal rules and regulations governing Medicare and Medicaid plans. In addition, plan managers face constant cost pressures to stay within state-allocated and enrollee budget limits while caring for highly complex member populations.

How HDMS helps

We offer Medicare and Medicaid plans opportunities for data-driven cost and quality control. Our sophisticated data analytics tools can help illuminate beneficial cost savings and quality improvement initiatives for even the most vulnerable and high-risk member populations.

Case study

South Country Health Alliance, a county-based health plan, turned to HDMS to leverage its large volumes of data to engage and improve outcomes for 41,000 members - all of whom are Medicare and Medicaid participants. With HDMS, the group's providers felt more comfortable taking upside and downside risk.

Challenges facing MCOs and regional plans

With fixed premiums, managed care organizations (MCOs) and regional plans take on more risk to ensure claims numbers hit the right targets. Knowing how to control member costs and design quality improvement programs is essential.

How HDMS helps

Our sophisticated data analytics tools have helped regional plans and MCOs measure and manage risk for years. We offer you the ability to identify the highest risk populations for more focused and effective cost and quality management programs.