The Health insurance industry is undergoing dramatic changes. Healthcare reform, regulatory mandates, and profit margin pressures are driving payers to focus on efficiency and cost reduction improvements. Compounding the situation is a maze of state and federal regulations imposing medical loss ratio (MLR) limits, and overly complex payment formulas for Medicare and Medicaid products are contributing to inefficiencies and lost revenue opportunities.
But new opportunities do exist. Tens of millions of consumers are utilizing Health Insurance Exchanges (HIXs) to select individual health plans for the first time, bringing a wave of new customers to the industry. While many payers will anticipate these new enrollments will be represented by a high probability of chronic conditions, insurers with an analytical edge can minimize the risk of providing care to these new entrants.
Fluent Analytics offers robust analytical solutions to harness a health plan's internal and external data to accurately segment and target preferred populations, competitively and profitably pricing each plan based on data-driven analysis, and providing a sustainable competitive advantage for future growth.