Insurance claims can be called the lifeblood of the American healthcare system. When a patient walks into a clinic, he or she gets treated and their visit is documented. Subsequently, it is coded and the claims are filled out to be sent to payers. The payers process the claim to check if everything done by the provider is valid and reimburse the provider for the services they provided. In other words, insurance claims make up most of the revenue cycles in healthcare.

Claims contain a significant amount of information about the patient, his or her medical condition, the treatments they underwent, and medication, coupled with demographic data such as gender, age, race, employment, and so forth. As most Americans have one kind of insurance plan or another, it amounts to about hundreds of millions of potential insurance claims. The insights in all those claims can go a long way in helping insurance payers to optimize their operations and health plans to serve the stakeholders better. That is where claim data can help.

Insurance claims data holds an enormous amount of information to help insurance companies as well as public health experts. Most working people have health plans offered by their employers or private plans they avail themselves of. As are the rules, each member’s health is determined and the premium decided, and if any member needs medical services, the nature of the services is included in the claim. The claims from all the providers can be compiled and analyzed in-depth to glean useful insights that would reveal patterns about diseases with regard to age, gender, ethnicities, as well as lifestyle and geographic location of the patients.

Moreover, health plan data analytics also reveal what percentage of Americans in which professions receive what kind of coverage in their respective professions. This insight is invaluable for public health experts to identify the problems or inequities in coverage for people according to the demographic information and professions. Over 30 million Americans are reported to be underinsured. This means that they won’t be able to receive the required level of medical care if they were to be injured or get sick. Additionally, an even greater number of Americans are estimated to be uninsured. As a result, they won’t be able to get any kind of care.

Insurance claims analytics, or simply analytics in insurance goes a long way in helping the fight for more a equitable healthcare system. Assessing the insurance claims systems sheds greater light on what’s wrong in the industry and helps experts, activists, as well as policymakers, pass more effective legislation for reform.

Analytics for insurance not only helps the payers themselves conduct their operations better but also serves as an effective tool to get a complete picture of the claims landscape. Implementing tools for insurance claims analytics reveals how much Americans spend on healthcare according to disease, race, location, as well as age, and gender. This insight is enormously helpful to identify which parts of the population are vulnerable to what disease, and framing policies accordingly.

The data and insights harnessed from claim management in insuurance could help identify the problems to solve to shift the system to a more value-based model. As the healthcare industry witnesses more investments and innovation, software for insurance claims analytics is bound to get better and better. It might be integral to making care more accessible to all.