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One of the biggest challenges in managing population health is the conversion and delivery of actionable information to appropriate resources. Defining patient populations is an important first step when identifying opportunities for clinical improvement, but this can be a challenging task. Healthcare technology now makes it easy for clinicians to find a specific patient population and help turn the analytics to actionable steps that improve outcomes.

The goal of digital transformation in the U.S. healthcare system is to drive affordability and accessibility of care. Accelerating care organizations’ movement towards this goal, the COVID-19 pandemic has made it necessary for healthcare organizations to explore better ways of adopting virtual care. Telehealth and COVID-19 have risen together, bringing about a phenomenal shift towards a virtualized care response throughout the country. Studies estimate that the demand for telehealth will rise by 64.3% in the U.S. in 2020, and the telehealth market is estimated to grow seven-fold by 2025, leading to a five-year compound annual growth rate of 38.2%. 

While value-based care is instilling more efficiency in the U.S. healthcare system, the need to procure and share additional data with other healthcare participants can be overwhelming. Before risk-based payment models had come into existence, under fee-for-service, simple information such as the names of the tests, assessments and procedures were sufficient for processing claims. However, under value-based contracts, healthcare payers also need to know the results to measure the quality of care outcomes. This includes items such as lab results, admission and discharge information, body mass index, vital signs and results of screening procedures and preventative health assessments.

The transition to value-based reimbursement in healthcare has created opportunities and challenges for health systems, physicians, and payers alike. Among all the interactions these stakeholders have, the relationship between physicians and health systems remains the most critical to clinical quality and efficiency, as well as the competitive success of each player. 

Healthcare consumerism is growing at an unprecedented rate, and health plan members are keen to access their healthcare data. When the data is relayed in a way that is easy to comprehend, with limited intricate technical terms, members can make prudent choices. Imparting information does not only empower the members, but it is also mutually beneficial. Along with healthcare data, if payers provide members with additional information about other health plans with lower out of pocket expenses, lower premiums and more coverage they can enable them to pick the most suitable plan and thereby instill brand loyalty. 

Every year health plans are required to gather and report their patient data for evaluation based on the Healthcare Effectiveness Data and Information Set (HEDIS®), a set of performance metrics established by the National Committee for Quality Assurance (NCQA). Until 2019, 90 percent of the health plans used HEDIS to measure their performance.