Health Plans Need to Ask The Following Eight Questions of Analytics and Tech Vendors

If you work on behalf of a health plan seeking to work with an analytics and technology vendor, then you might have questions. The answers to the following questions could help you decide if a current or prospective vendor is a proper fit for your organization.

1. Is the relationship that you offer to clients supportive or transactional?

Holding the same objectives and goals as your vendor is crucial to your success. By working with each other, you’re both moving in the same direction, instead of working with a vendor who only offers transactions. You might find some vendors who, in addition to offering risk adjustment analytics, also provide intervention services. Search for a vendor who does not have a vested financial interest in the number and mix of interventions you follow.

2. Do you offer full customer support across all products?

The data that healthcare analytics and technology companies provide often require a depth of subject matter expertise to fully utilize. Some vendors charge adjustable rates for their solutions and may take an a la carte approach to their support.

It is important to know whether the vendor you’re working with can ensure end-to-end delivery and support for all solutions, without any unexpected upcharge.

3. Do you prioritize accuracy and transparency in the analytics you provide?

Many vendors will tell you they prioritize accuracy, but some may have a more difficult time proving they prioritize transparency. It is important that these two key elements work together to effectively manage health plan risk adjustment and quality programs. 

Some in the marketplace will provide output data at the dashboard level, but not granular details, confidence values, financial value of gaps, or the value of the gaps combined. Look for a vendor who providers visibility into source data behind your programs so that you can target the right intervention, to the right members, at the right time.

4. What data do you share with clients to help them make decisions?

The answer to this question will often tell you how great a priority transparency is to the vendor you’re speaking with. The deeper the level of data provided, the greater the importance transparency is to that vendor.

You should be able to drill down to the source data behind any visual dashboards. By having access to deeper level data, you will be able to conduct your own special studies and validate the numbers you are provided.

5. What experience do you have in all lines of business, particularly Medicaid?

Health plans know that each line of business (LOB) has its own nuances. Therefore, one-size-fits-all solutions are not ideal. Look for a vendor with plenty of experience working for health plans in all LOB including Medicaid, Medicare Advantage (MA), Affordable Care Act (ACA), and commercial payers.

  • Affordable Care Act (ACA) – Because members in ACA plans tend to be younger and healthier, precision is key with this LOB.
  • Medicare Advantage (MA) – MA models prioritize financial forecasting, specifically with respect to Mid-Year Risk Adjustment (MYRA) and Final-Year Risk Adjustment (FYRA) impact analyses.
  • Medicaid – Medicaid models vary state-by-state, so state specificity is paramount for this LOB.

6. How precise is your suspecting logic and what files do you use to facilitate suspecting?

Precise suspecting helps generate greater precision analytics. Your vendor should be using both broad and deep data files to facilitate suspecting. At minimum, healthcare analytics and technology vendors should be considering medical and institutional claims data, lab results, and both mail order and retail pharmacy data.

7. How can you support us with our interoperability goals?

Interoperability is the goal for many health plans, clinicians, and other healthcare stakeholders. By focusing on interoperability today, your organization will be in a better position to transition to value-based care models tomorrow. 

Look for a vendor whose suite of products meets your comprehensive needs. Your healthcare analytics and technology vendor should prioritize innovation to ensure they are well-positioned to help address your goals now and into the future.

8. Are you equipped to understand how we’re using our analytics today and how we want to use them in the future?

Supportive partnerships allow for a deeper understanding of how clients use vendor’s insights today and provides a strong base from which to grow in the future.

Look for a vendor who offers software and platform solutions, home grown talent, and a team of experts who understand how analytic needs and solutions work together to help your organization reach current and future goals.

The answers to these eight questions can help you find the right partnership for your unique organization.

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