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Predictive Analytics a must for Healthcare Payers

I saw this report by Joanne Galimi of Gartner today - "Predictive Analytics a must for Healthcare Payers". The executive summary makes a great point:

The healthcare payer market is using current and historical data as a predictor of the future. Although business intelligence tools facilitate query and drill down into "what has happened," payers that maximize insight into "what is likely to happen" will sustain a competitive advantage.

As Joanne says, BI is not enough to deliver the value you need. She goes on to talk about how predictive analytics can be used in fraud detection as well as in a variety of care-related and marketing-related activities and credit-related decisions. While I agree predictive analytics are important, I think that the real focus should be on better decisions and that predictive analytics, as well as a focus on operational or front-line decisions and the use of business rules can make a huge difference in everything from care delivery to health maintenance. I also think employers will start to automate more of their healthcare decisions. Personally I think healthcare is going to see an explosion of decision automation over the next few years as we try and move to health maintenance and evidence-based medicine.

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