Health plans in the US have seen consistent advancements owing to the rising competition in the payer market. There are four critical factors that determine a health plan’s performance-outcome, process, access, and patient experience. The care delivery process and access to healthcare have seen significant improvement in the last couple of years due to developments in medicine and health plans’ robust provider networks and improved consumer digital interfaces.

Patient experience and health outcomes, however, have not shown a proportional upswing. Though health plans have come a long way there are still certain areas that need payers’ swift attention to drive optimum performance.

This whitepaper discusses the major factors that determine a health plan’s performance, the areas of improvement, and the necessity of a data-driven approach to drive better performance.