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Healthcare Payer Analytics Market

  • June 2014
  • -
  • Frost & Sullivan
  • -
  • 77 pages

A Look at What is Driving Payers’ Use of Analytics Solutions in 2014

In November 2013, Frost & Sullivan conducted an online survey, followed by a live focus group comprising C-suite executives from leading commercial healthcare payer organizations across the United States. The goal was to gain insights into how the health insurance industry approaches the use of analytics solutions going into 2014. For research purposes, analytics was defined as a solution in 3 categories: core platform solutions for big data functions, point solutions designed to address specific business needs, and external analytics vendors that payer organizations use to provide services or expertise. Issues analyzed include current (2013) and planned (2014) investments for analytics solutions, vendors and products deployed, and common challenges in implementing analytics initiatives. Top business drivers currently motivating payer use of analytics while accelerating future use have also been outlined.

Executive Summary

-The Affordable Care Act (ACA) is a key driver of widespread and growing interest in analytics that reaches across the healthcare landscape, encompassing providers and payers of care alike.
-In early November 2013, Frost & Sullivan conducted an online survey, followed by a live focus group with C-suite executives from leading commercial healthcare payer organizations across the United States. The goal was to gain insights into how the health insurance industry is approaching the use of analytics solutions going into 2014.
-For the purpose of the research, analytics solutions were divided into 3 categories:
-Core platform solutions for Big Data functions
-Point solutions designed to address specific business needs
-External analytics vendors that payer organizations use to provide services or expertise -Some of the issues examined include current (2013) and planned (2014) investments for analytics solutions, vendors and products deployed, and common challenges in implementing analytics initiatives. The research also considered the top business drivers that are motivating payers’ use of analytics today and accelerating that use going forward.
-The research results reveal that health plans will increase investments in analytics solutions and services in 2014.
-Key market drivers include the need to manage risk, to report on quality metrics, and to ascertain detailed metrics around cost drivers.
-Many payers face challenges in implementing an effective analytics strategy, particularly around data integration, complexity, and data governance.
-The new imperative for payer analytics presents numerous growth opportunities for vendors, particularly those that combine technology solutions with consulting and advisory services.

Research Objectives

-This survey was designed to gain deeper insights into the use of analytics solutions by healthcare payer organizations. The survey was also designed to offer a snapshot or synopsis of some of the key issues impacting payer organizations as they grapple with dynamic changes brought forth by the ACA, particularly the rise of health insurance exchanges (HIX), otherwise referred to as health insurance marketplaces.
-The analytics solutions were divided into 3 categories:
-Core platform solutions for Big Data functions
-Point solutions designed to address specific business needs
-External analytics vendors that payer organizations use to provide services or expertise
-Some of the issues examined include investments for analytics solutions, vendors and products deployed, and common challenges in implementing analytics initiatives. The research also considered top business drivers motivating payers’ use of analytics today and accelerating that use going forward.
-Although the respondent pool was not large enough to be statistically significant, ongoing monitoring of the market for analytics solutions used by payers and providers indicates that the findings revealed in this study will likely be indicative of trends among the broader payer industry.

Methodology

-In early November 2013, Frost & Sullivan conducted an online survey, followed by a live focus group with about 20 C-suite executives from leading US commercial healthcare payer organizations.
-The online survey—a series of multiple choice and open-ended questions, many of which were qualitative in nature—was sent to delegates planning to attend GDS International’s Next Generation Healthcare (NGH) Payers Summit from November 13 to 15, 2013. Online respondents were anonymous.
-The maximum number of respondents for most of the questions in the online survey was , and the average number of respondents for most of the questions at the 2013 summit was .
-Preliminary survey findings were presented at the NGH Summit and were incorporated into a focus group discussion of various topics that were designed to solicit additional insights and clarify concepts and issues discovered in the survey. About 25 delegates at the summit attended the focus group, most of whom had answered the online survey as well as some representatives from technology vendors.
-In addition to the online survey and live focus group, several thought-leader interviews were conducted with key vendors serving the payer analytics market.
-Reporting notes: Due to rounding, percentages in charts may not represent the exact number of responses for each choice and may not sum to %.

Table Of Contents

Healthcare Payer Analytics Market
1. EXECUTIVE SUMMARY

Executive Summary
Key Questions This Study Will Answer
Research Objectives
Methodology
Healthcare Payers—Majority of Respondent Types
Healthcare Payers—Respondent Organizations by Type
Healthcare Payers—Respondent Organizations by Number of Members
Healthcare Payers—Respondent Organizations by Revenue
CEO's Perspective
Executive Summary—3 Big Predictions

2. HEALTHCARE PAYERS—INDUSTRY DYNAMICS

Healthcare Payers—Industry Dynamics

3. HEALTHCARE PAYERS—MARKET DRIVERS FOR ANALYTICS SOLUTIONS

Healthcare Payers—Market Drivers for Analytics Solutions
Healthcare Payers—Select Responses on Analytics Needs and Challenges
Healthcare Payers—Most Impactful Issues Over the Next 5 Years
Healthcare Payers—Expected Financial Impact of ACA Over Next 5 Years
Healthcare Payers—Top Business Needs* Driving Analytics
Market Drivers—Categorizing Healthcare Payers' Analytics Focus Areas
Healthcare Payers—Types of Analytics Most Needed in 2014
Market Drivers Discussion

4. HEALTHCARE PAYERS—KEY ANALYTICS CHALLENGES

Healthcare Payers—Key Analytics Challenges
Healthcare Payers—Biggest Analytics Challenges
Market Challenges Discussion

5. HEALTHCARE PAYERS—EXPENDITURES AND ROI

Healthcare Payers—Expenditures and ROI
Healthcare Payers—Analytics Investment Plans for 2014 Compared to 2013
Healthcare Payers—Estimated Expenditures for Analytics in 2013
Healthcare Payers—Estimated Expenditures for Analytics in 2014
Healthcare Payers—ROI on Analytics Expenditures
Expenditures and ROI Discussion

6. HEALTHCARE PAYERS—ANALYTICS VENDORS

Healthcare Payers—Analytics Vendors
Healthcare Payers—Competitive Market Forces Impacting Analytics Vendors
Healthcare Payers—Number of Analytics Vendors Deployed Per Organization
Healthcare Payers—Number of Analytics Vendors Deployed Per Organization by Type of Solution
Select Analytics Vendors Mentioned by Respondents
Analytics Vendors Discussion

7. THE LAST WORD

The Last Word
The Last Word—3 Big Predictions
The 3 Big Predictions Discussion
Legal Disclaimer

8. APPENDIX

Appendix
Table of Acronyms Used
Market Engineering Methodology
Learn More—Next Steps

9. THE FROST and SULLIVAN STORY

The Frost and Sullivan Story
Value Proposition
Global Perspective
Industry Convergence
360º Research Perspective
Implementation Excellence
Our Blue Ocean Strategy

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