Skip to content

Data Strategies for Every Health Plan

Healthcare payers are using data in new ways to improve the member experience, reduce provider abrasion and streamline operations. In a recent interview with SmartBrief, industry strategist, Tyler Ford, vice president of strategy and partnerships at CAQH discusses key opportunities to better serve members and improve relationships with network providers.

What are some trends you’re seeing in health plans’ data strategies?  

One clear trend is the laser focus that health plans have on improving the member experience.  We’re hearing that plan sponsors – both public and commercial – are increasing their expectations when it comes to the services and information members have access to when making decisions.  Plans are building out data strategies with a more consumer-oriented framework.  That means new investments in price transparency or cost estimation, patient ratings and feedback, and even prescriptive guidance or recommendations.

What’s the most important issue health plan leaders should devote more attention to?

I think health plan leaders should be attentive to the way their organizational strategies influence the provider community to scale up. A great illustration of this is efforts to embed more clinical guidance and payment information into provider workflows. One example is giving prescribers access to their patient’s out-of-pocket estimates for clinically equivalent drugs at the point of care. 

We’ve heard a lot about payers vertically integrating with providers. How does that affect CAQH’s role in the industry?

We believe that members of every health plan need complete, accurate information on providers in their market to help choose the care that’s right for them. We also believe that providers deserve oversight and engagement when it comes to decisions and use cases that use their information. That’s why our model is based on consistency from data collection, aggregation, and sharing across organizations and provider engagement – a critical foundation for information exchange.


Read the full article.


Tyler Ford is the vice president of strategy and partnerships at CAQH, where he’s responsible for identifying growth and innovation opportunities aligned with CAQH’s mission through new payer-provider data solutions and corporate partnerships.  Ford’s focus is on collaboratively engaging health plans, providers and innovative companies to build the next generation of solutions and initiatives to streamline avoidable administrative costs across healthcare. Prior to CAQH, Ford held senior-level strategy and product roles at UnitedHealth Group and the Advisory Board. He is a graduate of Dartmouth College (BA) and the University of St. Thomas (MBA).