From analytics to outcomes: Powering value‑based care

In an era where collaboration between health plans and providers is more critical than ever, this mountain west health plan has emerged as a leader in transforming care delivery through data-driven innovation. Over the past decade, the health plan has steadily advanced its mission to lower costs and improve outcomes—culminating in a groundbreaking analytics initiative that is reshaping primary and specialty care. 

Through its strategic partnership with Truven, they have harnessed the power of Truven’s Health Insights and Flexible Analytics—converting complex data into advanced analytic models and actionable intelligence. These insights strengthen provider collaboration, build trust, and ultimately advance the shared goal of delivering higher‑quality, more cost‑effective patient care. 

[getModule name="blockquote" quote="Truven is helping us look at data differently than we did before. That software, plus predictive analytic and continuous measurement capabilities, allows us to drive smarter decisions through better outcomes – and save our large and small groups money.” author="Health Plan Chief Strategy Officer"]

From volume to value: A bold shift

Like most insurers, the plan once operated under a fee-for-service model, reimbursing providers based on the volume of services rather than the quality of outcomes. This approach drove up costs and offered little incentive for efficiency. Committed to making healthcare more affordable and effective for its members, this payer took a bold step more than a decade ago by becoming the first health insurer in its state to actively pursue a value-based care system. The focus shifted to aligning incentives between payers and providers, laying the foundation for a more sustainable, outcome-driven approach to care. 

The health plan partnered with Truven to implement Health Insights, a comprehensive healthcare analytics solution designed to transform complex data into actionable intelligence. The Health Insights enterprise analytic platform aggregates information from multiple sources—including claims, eligibility, and clinical records—and applies advanced analytics such as predictive modeling, clinical and event groupers, provider attribution, and case-mix adjustment. This enables faster insights that give providers the confidence to trust their data and act on it to improve care delivery and outcomes.   

The Medical Episode Grouper (MEG) is at the heart of the initiative. This is Truven’s rigorous, clinically rich episode construction methodology that integrates inpatient, outpatient, and pharmacy data into clinically meaningful episodes of care. MEG leverages the highly regarded and peer-reviewed Disease Staging framework. Disease Staging is a clinically grounded classification system that organizes patients by etiology, pathophysiology, and severity, which was developed in partnership with Sidney Kimmel Medical College at Thomas Jefferson University, to support quality assessment, resource utilization analysis, and outcome measurement.

Today, more than 190 health plans, employers, and state Medicaid agencies rely on MEG to compare medical and surgical options, evaluate cost and quality differences, and inform value-based care strategies. 

Built by physicians and trusted by physicians, MEG remains the gold standard in episode group construction, enabling stakeholders across the healthcare ecosystem to advance their value-based care goals with confidence.

[getModule name="blockquote" quote="We can provide our physicians with actionable data, so they know the lower cost, higher quality specialists, facilities or even drug choices outside of their offices. It’s an advanced healthcare technology that improves performances throughout the entire spectrum of care.” author="Health Plan Chief Strategy Officer"]

Real results that elevate value‑based care

These advanced analytics have been applied across 27 specialties and more than 1,000 episodes of care, resulting in:

• 3,100 providers across 635 clinics engaged in the health plan’s pay-for-performance model

• ~ $6.5M in annual savings (or ~$11 PMPY) attributed to analytics driven performance improvement

One compelling example involves orthopedic care. When the health plan shared cost data with a surgeon whose expenses were significantly higher than their peers, the surgeon quickly shifted to a high-quality surgical center, which dramatically lowered costs. This change contributed to a 3% reduction in orthopedic costs across the board. 

Further analysis revealed that members with osteoarthritis who did not receive physical therapy were six times more likely to undergo knee or hip surgery. In response, the payer redesigned benefits to offer zero-dollar out-of-pocket costs for physical therapy, improving access to conservative care options that often yield better outcomes. 

[getModule name="blockquote" quote="The innovative use of Health Insights and Flexible Analytics demonstrates what true leadership in value‑based care looks like. They’ve turned advanced analytics into a strategic accelerant. It’s about powering deeper provider partnerships, making smarter decisions, and seeing measurable improvements in patient outcomes.” author="Marcy Tatsch, Truven GM"]

Driving innovation through predictive model acceleration

Adding predictive power on top of these insights was a crucial part of the journey for this leading health plan. It implemented Truven’s Flexible Analytics, which is a free-standing analytic engine that allows clients to run analytic models on demand – groupers, risk scores, gaps in care, categorization models, etc. These models act as analytic accelerators that give data science teams a powerful head start. Instead of spending time on foundational model construction, data wrangling, and repetitive engineering, teams can build upon proven analytic structures that are already validated and ready to extend. By leveraging these accelerators, organizations dramatically reduce development time, improve consistency, and free their data scientists to focus on higher‑value innovation. It rapidly creates new predictive models, refines insights, and scales advanced analytics across specialties and use cases.  

Today, the team has implemented 15 predictive models spanning high-impact clinical areas. They began with a general model designed to anticipate members’ upcoming healthcare needs. From there, they rapidly expanded into targeted predictions, such as identifying who is likely to need surgery, who may struggle with COVID-19, and which members are at risk for behavioral health crises or hospitalizations. 

The accelerators also power deep insight into some of the plan’s highest cost conditions, including orthopedic episodes (back, hip, and knee surgeries), diabetes progression, and rare but extremely expensive conditions like end-stage renal disease.  

By combining Truven’s analytic intelligence with the health plan’s commitment to proactive care, the team can now build models faster, use them earlier, and act more precisely, turning advanced analytics into a scalable engine for value-based care. 

[getModule name="blockquote" quote="Their ability to rapidly build, refine, and scale predictive models reflects an extraordinary level of innovation. Their team didn’t just adopt advanced analytics. They leveraged Truven’s analytic accelerators to turn them into a powerful engine for smarter, faster, more proactive care.” author="Kevin Ruane, Sr. Strategic Account Executive, Truven"]

Better care at lower cost

This health plan’s journey proves what’s possible when clinical insight, advanced analytics, and strong provider partnerships are aligned behind a shared mission: better care at a lower cost. By pairing Truven’s Health Insights and Flexible Analytics with a deep commitment to value-based care, the payer moved beyond retrospective reporting to a new era of predictive, proactive, and collaborative care delivery. 

What began as an affordability imperative has evolved into a scalable, data driven operating model, empowering thousands of providers, improving outcomes across high-impact conditions, and delivering meaningful savings for members and employers. As the health plan expand its predictive capabilities, deepens provider engagement, and accelerates innovation, the partnership offers a proven blueprint for health plans nationwide to turn analytics into outcomes and make value-based care a sustainable reality.

[getModule name="blockquote" quote="We’ve learned that the key is meeting providers where they are.  If we had asked them to figure out the data on their own, we wouldn’t have made progress. Truven helped us bridge that gap.” author="Health Plan Chief Actuary & Analytics Officer"]