Gartner Research

U.S. Healthcare Payer CIOs: Achieve Provider Engagement Through Data, Analytics and CRM

Published: 08 August 2019

ID: G00409513

Analyst(s): Bryan Cole

Summary

U.S. healthcare payers’ fragmented provider network management systems reflect the dated demands of siloed business stakeholders. To improve provider relations, CIOs must catalyze business process rationalization and rearchitect IT systems around engagement hubs.

Table Of Contents

Analysis

  • Current PNM IT Systems Reflect Payers’ Outdated Fee-for-Service Business Model
  • New Provider/Partner Alignment Systems Architecture Enables the Health Value Orchestration Payer Business Model
    • Data Layer: Unified Source of Provider Data Truth Underpins the New IT Systems Architecture
    • Analytic Layer: Business Intelligence Foundation Adds Insight and Deepens Provider Orchestration Opportunities
    • Integration Layer: Connected IT Applications Increase Visibility and Enable Responsiveness
    • Engagement Layer: Provider Engagement Hubs Coordinate Next Best Actions for Quality and Financial Improvement
    • Communication Layer: Deliver Relevant Information to Providers When, Where and How They Need It
  • Conclusion: Provider/Partner Alignment IT Systems Architecture Enables Payers’ Digital Business Ambitions

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