Improving health outcomes and patient experience with decision intelligence

Health systems are more interconnected than ever, as payers and providers form value-based care agreements that blur the lines of where one organization's responsibilities and services end and another's begins. This industry shift requires sharing member and patient records and insights to deliver quality services. Payers and providers bear equal responsibility for members' and patients' overall health and experience. But these organizations have yet to fully address the need for sharing data and insights that optimize medical costs, manage health risks, and provide quality of care.

When the Centers for Medicare & Medicaid Services recently changed parts of its Medicare Advantage programs to reduce healthcare costs, protect consumers, and ensure high-quality care, it made the demand for increased collaboration between payers and providers even more urgent.

Alongside these developments, three megatrends are emerging in the healthcare sector:

• The need for interconnected health systems that allow seamless data integration between payers and providers
• An increase in risk-based value share models that require enriched risk stratification to measure, for example, an individual's likelihood of an emergency hospital admission, and ultimately improve care management decisions and wellbeing
• Greater emphasis on realizing health equity, changing patient and member behaviors, and enhancing their experiences

Health plans and systems have an opportunity to safeguard their risks, minimize lost medical costs, and improve their ratings by integrating digital services with health records and using analytics and dashboards to provide insights they can act on. But without an effective end-to-end, interconnected solution available, many organizations have spent millions of dollars building data foundations that have not yielded results. The industry needs a flexible and scalable approach to data interoperability.

Genpact's Healthcare Decision Intelligence solution turns data into insights, action, and outcomes. It fills the gap in the market as an integrated, scalable healthcare ecosystem that embeds insights into care delivery processes to maximize business value and improve patient health.

The key components of Healthcare Decision Intelligence:

• Data connectors accelerate the integration of various data sets, including electronic health records, insurance claims, pharmacy and lab records, social determinants of health, information from admission discharge transfer systems, electronic health information exchange data, and immunization records
• A healthcare data warehouse and data lakes aggregate, normalize, and manage healthcare data with intrinsic rules and risk stratification models
• Agile analytics and care modules provide prebuilt data models for care coordination, population health, tracking quality measures, and pharmacy adherence

Healthcare Decision Intelligence raises the quality of care, enhances member and patient experiences, increases cost savings and revenues, and streamlines operations.

The solution enables organizations to save by:

• Securing value-based reimbursements from healthcare effectiveness data, closing information gaps in the established Healthcare Effectiveness Data and Information Set, and improving star ratings
• Cutting the total cost of care through enhanced utilization management and fewer admissions to emergency departments
• Achieving operational savings by providing care managers with easy access to electronic healthcare data that frees them to focus on patient care and outcomes

Having adopted our solution, we've found that medium-size payers, for example, can expect a 20–30% ROI during the first year of deploying the solution, 40–60% in the second year, and 80–100% in the third.

A private health insurance company faced rising healthcare costs but wanted to avoid passing this burden onto its members. The company also sought to grow its analytics capabilities to find new ways to stay competitive.

Working with Genpact, the company set out to enhance its agile analytics strategy, solution development, and delivery model. In just 11 months, we used agile analytics to create several solutions, including a machine-learning solution that identifies product portfolio gaps and a dynamic dashboard that highlights hospital and provider network performance. The creation of reusable data and analytics sped up future solution development.

Over three years, Genpact developed digital analytics-backed solutions for member risk management in healthcare, member engagement and experience, provider benchmarking across quality and cost of care, a star rating prediction model, and product design.

Through our work, we increased efficiency across the company's operations to identify $75 million in potential cost-saving opportunities. We also advanced marketing campaign targeting to reveal revenue opportunities of $55 million for promoting new pharma delivery services. With enhanced capabilities and a foundation for rapid solution development, the insurer is building a strong future using the power of analytics.