Uncertainty surrounding reimbursement and coverage models plagues payors (including both public and private entities). Furthermore, sustained growth is under pressure from population level trends, including elder care, health disparity, and chronic disease. Payors require the ability to limit fraud and mismanagement, leverage preventive care models, enable population level awareness and outreach, and implement disease management initiatives.
The integration of population-based operational and analytical information warehouses will foster better surveillance, epidemiology studies, and comparative effectiveness research, leading to iterative improvement of public health. Applying the use of secure data warehouses will allow for a reduction in fraud and greater integration between caregivers. By utilizing this approach, payors can effectively move towards a preventive model of care and allow for billions in savings annually from reduced fraud and redundancies. Taking these steps will allow for greater integration and improve outcomes for patients and the foundation for evidence-based care. By reducing acute episodes and shifting towards prevention, payors will realize consistent growth in revenues.
Through the integration of information, payors will be able to take more active steps towards preventing disease in patients, especially those with chronic conditions. This will result in fewer costs associated with acute episodes and through prevention in both initial and secondary care. Payors also require integration with health professionals, patients, healthcare systems, and research organizations that will enable more robust business models.