Transparency Precipitating Innovation: How Data Analytics Hold The Potential To Spark A Revolution in Health Care

Affordable Health Care

The last two years generated 90% of the data in the world today.(1) This mass of data gives healthcare an unprecedented ability to gather healthcare intelligence to inform clinical and business decisions. The Big Data Healthcare Analytics Forum stated:

Big data is a term used for massive amounts of information that can be interpreted by analytics to provide an overview of trends or patterns. Organizations leverage big data by gathering records and information captured and then interpreting it with analytics. Common in other industries, big data has only recently begun to become a factor in healthcare. Its applications range from provider-specific business intelligence to scouring over an entire state’s health records to pinpoint people who are at risk for certain ailments.(2)

Harnessing the power of your data will provide healthy returns in terms of health outcomes, reduction in healthcare spending, opportunities for consumer education and engagement.

What Claims Data – Properly Analyzed – Can Reveal

The source of data analytics for self-insured plans is taken from claims data. Claims reveal the detail on how funds are being used: who is using them, what they are paying for, to whom they are paid, geographical trends and much more. When presented on an effective data analytics platform, claims provide valuable information that can be transformed into healthcare intelligence.

Currently, utilization review programs assess data on a micro level. Addressing utilization on an individual basis and by diagnosis group has a vital impact on cost trends in care delivery. However, an integrated, retrospective analysis of the information is difficult to perform.

A data analytics platform creates transparency in aggregate information, and reveals trends in the population health, geographic spending, and provider and patient behavior. At the same time the platform has the ability to drill down to an individual consumer’s utilization. Trends, hotspots, outliers and exceptions are presented in easy to read dashboards that are trended and followed by physicians who guide and direct care initiatives. Gone are the days of viewing spreadsheets and tables to analyze data.

Data analytics is a powerful tool to leverage information, guide educational initiatives, identify value-based providers and shift the trend of unnecessary health care spending. It truly has the power to revolutionize understanding and planning of health care.

How Data Intelligence Guides Care and Why It Matters

Value-based health care providers are defined as those delivering high quality care, good health outcomes and an exceptional healthcare experience to the consumer. These providers pop out of the data analytics dashboard. High complexity patients that are well managed at lower costs are easily identified; in the same way, low complexity patients managed at higher costs are also exposed. This information provides teaching opportunities both to providers and patients. Transparency gives everyone the opportunity to choose value-based care. Healthcare consumers who are outliers are identified and interventions made to ensure they receive supportive or specialized services.

The intelligence gathered from data analysis guides care across the continuum. The near term opportunities to prevent and reduce hospitalizations, slow the progression of chronic disease and utilize value-based care providers can be implemented immediately. Causes of waste in healthcare spending are recognized, analyzed and proactively addressed. Identifying the causes of excess spending often require a 360 degree view that only data analytics can provide. When analytics are combined with the clinical expertise of providers, effective interventions can be designed and implemented.

US Med Care Club clients have access to powerful data analytics that reveal hot spots in spending, risk stratification of their membership, and pathways to value-based care. The possibilities for a revolutionized health care system just got bigger with big data.


  1. SINTEF. “Big Data, for better or worse: 90% of world’s data generated over last two years.” ScienceDaily. ScienceDaily, 22 May 2013. <>.
  2. Larson, K. NetApp Healthcare. Data management & the Key Role it Plays in Transforming Care. Big Data Healthcare Analytics Forum. Boston, MA . November 2014.
  3. “Module 4: the quality enterprise and VBP principles–case studies.” Berthiaume JT, Dobson LA Jr, Heuser GK, Salgo P, Weissberg J. Am J Managed Care. 2013 Jul; 19 (9 Suppl): s180-2; PubMed 23919490