Is your members’ health data working for you or against you?


Consumer health data is being collected from members at a record pace.

It comes from your members’ devices, your prescription suppliers, your providers’ EHRs, and your own member portals – but the burning question is, how are you using it? Does this data help you in any way? Are you positioned to use data to improve member outcomes, to save both them and your organization money? Has it ever helped you recommend new low-cost, equally as effective prescriptions to your high cost members?

We often find that health insurers already have insights within their data, but are not set up to extract those insights to make them actionable.  To do this the data must be consolidated, aggregated and analyzed in context of the individual member.

Payers already have piles of data and are perfectly positioned to mine it.

Payers have accumulated a large amount of data, from across a member’s healthcare journey.  These data can be mined and connected with other systems that payers have access to. Most have a data warehouse practice. However, the slowness of today’s large enterprises often makes it take too long for actionable insights to impact consumers in a meaningful way. Data warehousing provides tons of material for retroactive, summary reports, but provide limited insights into improving consumer health. Additionally, we find that payers also struggle with:

  • Slow claims data processing, which often take months
  • Modern technology knowledge, in-house knowledge is often for support and maintenance of legacy systems and enterprise applications
  • Outsourced teams, which makes it difficult to be agile.
  • The need for high initial capital expenditure for improvements

Others in healthcare have their own challenges.

EHRs also have valuable data but they are often trapped behind proprietary systems that make it costly and complex to get your data.  A report by the Office of the National Coordinators for Health Information Technology (ONC) released last year points out the barriers that have been erected by HIT vendors and healthcare providers.  SMART on FHIR is one potential solution to breaking down these barriers, but there’s still plenty of work to be done to make interoperability a reality.

Specialty health and wellness providers, such as incentive providers, know a lot about health plan members too but they typically are not able to leverage any of the data due to their size and technology constraints.

There’s hope to unlocking the power of your members’ data – key data technologies are becoming increasing more available.

Cloud data warehousing solutions are shrinking the gap to where gaining insights is attainable without massive investments.  Solutions such as Google’s BigQuery and Amazon’s Redshift are leading the way.  Although these solutions require you to send all your data to the cloud, de-identification strategies can be employed to make solutions HIPAA compliant.

Recently open sourced Greenplum and CitusDB are going to allow for new usage scenarios to be developed that will allow low cost fast-to-market solutions that live on-premise, making HIPAA compliance less of a concern.

Amazon Redshift, Google’s BigQuery, Greenplum, and CitusDB are compelling tools that have yet to be fully utilized in the healthcare space.

Being an innovator in healthcare is about leading.

Even after your technology and data are in place, effective experimentation and learning about health consumers will take time. Payers that want to win need to take the first step and should expand their technical capability and internal skill sets to enable them to best leverage their data. Those that wait, risk being left behind, or worse yet dying as not only competitors, but regulators and market trends around reimbursement models demand the type of population health optimization we’re beginning to see.


  Medullan has a platform offering that addresses some of these issues. To learn more about our solutions, contact us.


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