3 ways health plan members benefit from real-time data in healthcare

2. Aligned data around new drug releases

Managing the use of costly new therapies is the responsibility of both payers and providers. But siloed information can negatively impact payer management and provider communications. Payers benefit from breaking down these silos to better evaluate therapies, manage costs, and improve member care and satisfaction. This task is particularly difficult for new drugs that have outpaced evidence and where conflicting or confusing policies have emerged around their use. Addressing this issue requires improved technology integration that prioritizes the alignment of therapeutic and coverage decisions to keep up with drugs that are in high demand.

For example, GLP-1 drugs are rapidly increasing in popularity. Use increased 40 times between 2017 and 2021—2-3% of the United States population could now be on one of these drugs. This rapid increase in use opens potential gaps in coordination between providers and payers, who might not be operating with the same clinical recommendations or evidence. This dynamic creates potential issues in policy coverage, leaving members in the middle. A smooth member experience with GLP-1s requires coordination of clinical data and evidence-based information between providers and payer benefit teams.

3. Improved coordination with providers

A personalized member experience requires coordination between providers and payers. When care management teams are using the same data as providers, members are more likely to receive consistent messaging around therapies, wellness, and overall care. This coordination contributes to more consistent outcomes, increased member satisfaction, and improved results for all stakeholders.

Care management teams should align with provider efforts to educate patients and should ground member educational materials in evidence-based information.

Data alignment relies on the right technology

The massive amount of data flowing between payers and providers can create barriers to facilitating true alignment and improved benefit design. Payers should look for a trusted vendor partner whose technology is designed specifically for their needs. Look for solutions that leverage the advantages of data integration to coordinate payer evidence and data with provider talk tracks and scripts—a critical step in improved service delivery and creating a superior member experience that’s consistent across payer and provider interactions.

UpToDate® harmonizes data at the payer level, featuring evidence-based clinical guidelines that inform member education and member benefits with the same information providers use in clinical decision making at the point of care. On the pharmacy side, Medi-Span® standardizes and streamlines drug coding and classification—critical to simplifying integrations between medical and pharmacy benefits. By implementing this class of solution, payer leadership can more easily reduce friction with provider workflows, resulting in improved member engagement with health services.

Turn lagging member outcomes into success stories

Data alignment powered by real-time evidence is the foundation for improved care delivery and a high-rated member experience—driven by coordinated care and superior outcomes while implementing healthcare cost management strategies. This level of evidence-based support fosters trust, engagement, and ultimately satisfaction, even among the most challenging member groups.

To learn more, download this eBook on aligning payer and provider data strategies.