A provider 360 approach allows medical insurance payers to access the broadest and most up-to-date collection of provider data possible. This approach offers payers a unified, all-encompassing view of healthcare provider data that includes clinical, operational, financial, and social factors influencing care delivery.
With a provider 360 approach, payers can view a comprehensive provider profile that integrates data from claims, patient outcomes, performance metrics, feedback, and social determinants of health. Thanks to the power of the modern data stack, all of this information lives in one, highly-accessible place, making it easier than ever to incorporate provider information into the payer’s decision-making process.
In this article, we will discuss how the provider 360 approach helps healthcare organizations improve care outcomes, not just by making provider data more accessible but also through cutting-edge features like data-driven risk analysis, operational metrics, and decision-making.
A Provider 360 Strategy isn’t Just About Data Aggregation, It’s About Data Optimization
The power of the provider 360 strategy lies in its comprehensive, up-to-date aggregation of provider data. By collecting and integrating data from multiple touching points (like claims, EHRS, patient surveys, outcomes), this approach provides payers with holistic, real-time provider profiles.
A profile includes not just the provider’s clinical capabilities but also their historical treatment outcomes, patient satisfaction scores, and engagement with care programs. This comprehensive view enables payers to make informed decisions when selecting providers and thus improve the overall quality of care delivered to members.
A holistic provider view doesn’t just blindly aggregate provider data either; it can be used to analyze data in order to reveal, for instance, performance gaps or trends that suggest a provider is treating higher-risk populations or not following best practices for care management. By analyzing claims data and risk assessments, the provider 360 approach empowers payers to guide providers to adopt best practices, improve care delivery, and reduce unnecessary hospitalizations and complications.
In the next section, we’ll discuss other specific use cases for a provider 360 approach, ranging from more optimal patient-provider matching, better identification of operational inefficiencies, data-driven recommendations for next best actions, and the alignment of provider incentives with provider healthcare goals.
Four Transformative Use Cases for Provider 360 Data
- Addressing Social Determinants of Health: Payors can identify and even assist providers who are uniquely attuned to the social determinants of health that impact their patient, such as access to transportation, food insecurity, and housing instability, enabling them to match members with providers whose practices align best with their needs.
- Improving Operational Metrics and Efficiency: Analyzing call statistics, common provider-related issues, and root causes of inefficiencies in the system can empower payors to identify and resolve operational issues, improving member experience in the process.
- Defining Next Best Actions for Providers and Patients: Payors are empowered to confidently recommend next best actions to both providers and members, such as referring high-risk members to specific care programs or preventative screenings, as well as encouraging providers to engage with care management resources or technology solutions that can improve care coordination.
- Aligning Provider Incentives with Population Health Goals: Provider incentives and population health goals can now be effectively aligned, allowing payers to use data to ensure their overall goals for population health management are being incentivized. For instance, shared savings or financial bonuses could be offered to providers who demonstrate a reduction in hospital readmissions or an improvement in vaccination rates.
Hakkōda Helps Healthcare Payers Tap into the Benefits of the Provider 360 Approach
Here at Hakkoda, we know just how difficult it can be for healthcare payers to protect their bottom line while cooperating with providers to ensure optimal patient outcomes. The modern data stack offers tools that truly are capable of transforming operations to create a level of efficiency and efficacy that was previously impossible.
Our healthcare data experts are ready to help your organization implement a provider 360 approach, empowering you to make data-driven decisions that will keep your company ahead of the curve. Let’s talk today about how we can help you make the most of provider data with a modern data stack that’s designed to protect your bottom line, foster better collaboration with providers, and improve patient outcomes.
