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5 Key Steps for Health Plans to Implement an Effective Business Intelligence Strategy

In a recent study of health plan executives, participants were asked to identify where they see an immediate opportunity to better manage costs. The top response was through interoperability and being able to share data with constituents across the healthcare ecosystem.

Health plan executives are taking a closer look at the power of their data and enhancing business intelligence strategy as part of their digital transformation. VillageCare, a community-based, not-for-profit organization serving nearly 20,000 seniors, people with chronic care, continuing care, or rehabilitation needs in New York, is one of the payers leading the way.

VillageCare noticed that managing data was becoming an impediment to running the business. In a webinar sponsored by ACAP and HealthEdge, VillageCare CIO Stuart Myer shared his perspective, “We were spending too much time validating the source and accuracy of data. It was becoming one of our biggest pain points.”

As VillageCare leaders embarked on their digital transformation journey, they prioritized business intelligence, data accuracy, and information exchange as foundations of success.

Here, we highlight the organization’s challenges, steps to solving them, and the powerful results they have achieved to date.

The Information Challenge

When health plans lack a single source of truth and integrated solutions, they experience challenges, including:

  • Unreliable, out-of-date member and provider data
  • Inefficient, time-consuming processes
  • Incorrect benefits and eligibility information
  • Inaccurate payment and claims processes

These data problems created frustration for providers, members and health plan teams and resulted in costly errors and inefficiencies.

The Solution: A Digital Foundation with a Business Intelligence Focus

As VillageCare evaluated their options, they prioritized data strategy and sought a partner to collaborate with them in their goal to become a data-driven organization. Here are five steps health plans like VillageCare can use to implement an effective business intelligence strategy:


Consider data strategy as the foundation for digital transformation so that process and implementation is designed with integration and flow of accurate data at the center. Develop an overarching strategy that touches each area, while considering that all do not have to be completed at once.


Identify a technology partner that understands your data goals – both the business and technical. Ensure the partner embraces standards and can provide solutions that integrate with each other as well as other best-in-class solutions. VillageCare found that partner and the right solution to support their business intelligence goals in GuidingCare from HealthEdge.


VillageCare established a central source of truth, integrating other applications and allowing them to become owners of their own provider data. “Rather than having others submit provider files and formatting, we are owners of provider data that feeds other environments. We are exposing provider data through CMS FHIR standards. This is beneficial for members. We also make it available to Medicare benefit advisors, so they have real-time information on who is in the network,” explained Myer.


Incorporate standards such as FHIR to standardize the flow of information across the health plan, partners, and providers.


Introduce processes and train teams to ensure the entire interconnected ecosystem is using the established source of truth. Maintain data hygiene to uphold information quality standards

“As we evaluated technology vendors, we looked at the key components to ensure they were logically grouped with integrations in the best areas. For example, we needed care management to be tightly coupled with utilization management, appeals and grievances, and an authorization portal for providers. We wanted to ensure data was available for population health and member services; not just for regulatory needs but to truly improve business operations. We looked for a vendor that could support us in our effort towards becoming a data driven organization, having an analytical focus, and implementing use of business intelligence across several different areas.”

Stuart Myer Chief Information Officer, VillageCare

Results of an Effective Business Intelligence Strategy

VillageCare enhanced its business intelligence strategy as the team embarked on a digital transformation journey by implementing GuidingCare from HealthEdge. The initiative has already delivered powerful results:

  • Better access to accurate data for members, providers, partners, and other stakeholders
  • Improved care and outcomes for the community served
  • Reduced costs through more efficient processes and workforce
  • Enhanced quality and compliance through more accurate reporting

“Everything became interconnected through the use of data, standards, and the right technology partners. [This] allowed us to create the foundation to enable a true digital transformation across the organization,” concluded Myer.

To learn more about enhancing your business intelligence strategy as part of a digital transformation and leveraging GuidingCare, visit HealthEdge at Care Management Workflow Software | GuidingCare HealthEdge.