IBM Business Analytics solutions provide health plans and insurers with systematic planning, analytics, reporting and predictive capabilities to drive operational efficiencies, enhance quality and improve member services to support profitable growth—while meeting regulatory and compliance demands.
IBM Cognos business intelligence (BI) and IBM SPSS predictive analytics software enables health plans to:
Improve operations and identify cost take-out
- Gain insight into claims processes and administrative expenses
- Enable operations managers with information to support collaborative decisions
- Provide self-service reporting and analysis to employers and network providers
- Analyze patterns and trends into call center operations and member services
- Mine web traffic and utilization to optimize member experiences
Gain a single view of business performance
- Increase the quality of decisions by providing more accurate and precise information
- Integrate data from disparate systems, databases and sources for greater insight
- Enable timely and consolidated monitoring, analysis and planning of operations
- Empower users with complete, consistent and relevant information in the context they require
Support member health: improve clinical efficiency, quality and outcomes
- Enable population analysis, quality and wellness programs
- Support disease and case management initiatives, pay-for-performance programs and clinical research
- Identify and manage trends in treatments, quality, provider performance and clinical quality
- Support transparency and quality reporting to employers and consumers
- Model scenarios for disease profiling, spotting predictive events and supporting prevention initiatives
Optimize provider, product and portfolio performance; reduce risk
- Monitor key provider performance metrics to strategic goals; identify trends and opportunities
- Analyze and optimize product features and portfolio servicing across networks
- Support portfolio planning with greater insight into profitability and utilization patterns
- Analyze and model risk patterns and events to identify, predict and minimize fraud
