To meet current and future value-based care and equity health outcomes, payers need a clear, strategic data strategy to support a whole-person view of members.
Providing equitable, whole-person care has become a major driver for the payer market. It offers the opportunity to proactively mitigate long-term health challenges, lower costs, and build deeper relationships with members.
However, adapting from managing members at a population level to using data and insights to drive personalized, and perhaps even individual efforts, at scale requires new approaches to how member information is gathered, synthesized, and utilized.
Helping to drive this renewed focus on equity are the changes coming to the Centers for Medicare & Medicaid Services (CMS) Health Equity Index in 2027. New standards and data reporting on improved care, equity, and outcomes will have a direct impact on Stars ratings. Having the right data strategy in place will be foundational to these reporting efforts, but payer organizations and leaders have their work cut out for them to prepare the data infrastructure and information exchanges.
However, if done effectively, a holistic data strategy can not only help companies maintain or improve their Stars ratings but also create opportunities to better connect with and engage members for better outcomes.
Data reporting challenges for payers
Understanding current data challenges within payer organizations is key to addressing them and building successful strategies. Many payers don’t have the right data infrastructure in place yet, increasing the need to focus now rather than closer to the CMS changes.
