A Data Intelligence Cloud for Healthcare Payor Transformation Analytics

Delivering value-based care with seamless, scalable, and intelligent solutions while harnessing data and AI to drive profitable growth and better manage risk has become the rallying cry for healthcare payors in today’s rapidly changing market. Being able to understand the hundreds of data points from within the enterprise as well as publicly available data to analyze and model risk, price, and market potential is the prime catalyst for healthcare payor AI transformation projects.

But fragmented data and inefficiencies make it hard to differentiate legitimate claims from fraudulent ones at scale, leading to increased overbilling, while lack of member engagement leads to higher healthcare costs and lower satisfaction scores and inefficient provider workflows lead to frustrating experiences for both providers and members and lower the quality of care overall.​ The solution is centered on cloud migration for next level scalability, security and advanced analytics, but adopting a cloud solution is complex, with risk of disruption to customer health and payment history.

Embracing these technologies successfully requires a strategic approach and alignment between IT and business objectives.

Why should healthcare payor professionals care about a data intelligence cloud?

It would be an understatement to observe that healthcare payor professionals are experts in their field and are not usually comfortable with the rapid advancements in technology. So, having the ability for an average business executive to “converse” with a machine using natural language (NLP) to get the analytics they need to make better decisions, streamlining business operations to delivering unparalleled customer experiences and decreasing operational risk by inspecting hundreds of variables instantaneously identifying the potential to healthcare payors looking to modernize their analytics and risk platforms to improve provider and member experience, operational efficiency, fraud prevention, and regulatory compliance.

Modernization of legacy applications has become a “need to have” for healthcare payor organizations looking to maintain their competitive standing and operational profitability. Instead of continuing down the path of proprietary solutions that require dedicated tools and resources, many are now evaluating an data intelligence cloud solution that leverages new advancements in GenAI and reinforcement learning. Simply put, a data intelligence cloud is a cloud computing platform that leverages to power of GenAI to enhance its capabilities and transform data into usable information accessible by the average person, allowing them to harness their organization’s full potential by capturing and harnessing the right data, advanced analytics and AI capabilities. Bottomline, it democratizes AI for "Citizen Data Scientists.”

Payors face critical obstacles that hinder their transformation journey:

• Hard to differentiate legitimate claims from fraudulent ones at scale, leading to increased overbilling.
• Lack of member engagement leads to higher healthcare costs and lower satisfaction scores.
• Inefficient provider workflows lead to frustrating experiences for both providers and members and lower the quality of care overall.

Improving outcomes and optimizing healthcare payor analytics

A successful AI transformation/data intelligence cloud project for healthcare payor operations and analytics will empower business leaders to get actionable insights in real-time while maintaining security and privacy and free data analysts to innovate instead of generating reports. Some of the specific use cases include:

• Reduce fraud and fast-track approvals: Use GenAI to detect fraudulent patterns and reduce overbilling. Automate approvals for reliable providers.
• Improve member experience: Use GenAI to Enable greater price transparency and personalized engagement across various stages of the member lifecycle.
• Align with value-based care: Use GenAI to attract and retain quality providers by allowing them to focus on patient care rather than administrative tasks.

New developments in open-source, zero-code SaaS platforms mean that legacy system modernization projects can be tackled with a data intelligence cloud that reduces dependencies on proprietary systems and the costs of dedicated tools and resources. So, the good news is that you won’t have to wait months or even years to realize the benefits of an intelligent cloud for your life sciences operations.

Deliver value in days or even minutes instead of months or years

Vendors like UBIX deliver on the promise of a zero-code, highly scalable and flexible cloud architecture that leverages the best-in-class cloud technologies to support modern data workloads, including analytics, AI, and ML. A perfect fit for any healthcare payor AI transformation or intelligent cloud project. With an architecture that is designed to adapt to the varying demands of healthcare payors, allowing them to scale up or down based on their specific requirements - enhancing provider and member experience, operational efficiency, profitable growth, fraud management, and compliance. Here are three examples of the many ways it can be used:

• Assisted Compliance: enable healthcare payors to automate compliance, cut administrative costs, and avoid penalties by improving oversight and corrective actions.
• Health Service Analysis: leverage data analytics to understand patient demographics, optimize financial and claims processes, perform geo-spatial analysis, and analyze healthcare utilization for improved service delivery.
• Personalized Health Plans: enable personalized health plans by predicting individual healthcare costs, blending private and public data, and customizing patient models to deliver optimal coverage and boost member engagement.

Learning how GenAI and emerging advancements like Reinforcement Learning can deliver on the promise of a data intelligence cloud for healthcare payor analytics has never been easier. Download our free eBook titled “Solving the Problem of Data and Decision Making” to help better understand the nuances of emerging AI concepts and technologies and offer a set of best practices for consideration to ensure digital transformation and business-led AI success. Or if you can spare 22 minutes for a mini–AI Readiness Workshop, you can contact one of our AI experts today.