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Three strategic guideposts for health plans in the fast-paced digital age: Part 1 - Data democratization

Today’s near-real-time digital communication, access to information, technology progressions and rapid processing speeds have emerged at a breakneck pace across healthcare. In fact, Statistica projects the global digital healthcare market to reach $660 billion USD by 2025.

As all of healthcare works to navigate a data-hungry world, businesses search for solutions to address the growing abundance of information that’s reshaping the world as we know it. What does it all mean for health plans?

To thrive in this quickly evolving digital age, health plans can use three strategic guideposts to position for the future: 

  1. Data democratization
  2. Health equity
  3. Payment integrity

This is the first in a three-part blog series that will explore each of these areas as well as the power of business process as-a service (BPaaS) to help health plans excel across all of them — improving data-informed insights and decisions; enhancing member experiences and outcomes; and strengthening compliance and competitive agility.

Data democratization

Data democratization involves making data access and analytical capabilities available to a broader range of users. For health plans, that means both internal and external users. Historically, data availability has been concentrated in the hands of a few, creating bottlenecks and inhibiting timely healthcare and operational decisions. Data democratization breaks down barriers and empowers individuals at all levels to access, analyze and interpret data safely and securely.

When health plans have the right technical competencies, it paves the way for countless strategic and operational improvements, e.g., fine-tuned population segmentation, call planning, resource allocation and proactive communication with providers and members.

Healthcare data access and ownership

Electronic health information (EHI) took on regulatory definition under the 21st Century Cures Act requiring providers and payers to give patients access to any electronic personal health information (ePHI) in their designated record set (DRS). With federal regulators enforcing patients’ access to and ownership of their data, the convergence of administrative claims and clinical data is underscoring how crucial data democratization has become. 

As plans consume and share more information, it will take specialized technology expertise and infrastructure to effectively navigate evolving operational demands and challenges. New trends — like dashboards and portals — are taking shape as plans work to deliver more transparency of claims data, provider performance, analytics and population health segmentation. 

These technology engagement capabilities are becoming musts for health plans: 

  • A robust, user-friendly dashboard enables a health plan to “keep its finger on the pulse” of essential operations, including financial performance, claims management, provider and member engagement, care management, member health and more. 
  • Web portals and application programming interfaces (APIs) are now fundamental to digital interactions. Even by 2018, 88% of U.S. customers expected all organizations with which they engaged to have an online self-service portal. But it’s not yet a one-stop-shop where a member/patient can access a comprehensive view of data that’s “untethered” to a single entity. 

Healthcare portals are mostly confined within a single organization leaving patients to contend with separate portals for their primary care, hospital, specialists and health plan. Being tethered within siloed entities like this makes a longitudinal view of information nearly impossible. 

Ultimate data democratization would give individuals direct control over the data they store and share with others from a centralized point of interaction. To solve this data interoperability conundrum and accomplish ultimate information liquidity combined with security, plans need to strike the right balance leveraging a combination of technology advancements and expertise to ensure their capabilities can meet current and future demands.

How can BPaaS help?

BPaaS solutions can significantly improve the operational ecosystem for health plans — especially small to mid-size plans. When done right, BPaaS and data democratization are interdependent concepts that work together to unlock the full potential of information. Combining infrastructure, tools and expertise, BPaaS delivery options can provide user-friendly interfaces, intuitive dashboards and self-service capabilities that empower efficiency and actionable data insights. 

Overall, BPaaS can be a catalyst for plans to quickly advance their capabilities, helping small to mid-size health plans compete, providing robust data governance, security, visualization and reporting — and making data more accessible and understandable to a wider audience.

In a digital era where data is the lifeblood of businesses, harnessing its power is crucial for health plans’ success. Those taking steps toward data democratization empowered by BPaaS will gain a competitive edge. 

Stay tuned for parts two and three of this series in the coming weeks.

Conduent’s BPaaS Solution for Health Plan Administration, empowers health plans across every aspect of their operations — from enrollment and claims processing to member and provider services, payment integrity, care coordination and more. Learn more on our website.

About the Author

Jeff Hickerson is a senior executive at Conduent with over 25 years in the healthcare industry. His experience spans multiple facets of the healthcare ecosystem including payer services, care management, hospital revenue cycle management and BPO. His roles have included overseeing product management, account management, strategic planning, project management and more. Jeff can be reached at

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