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How Health Informatics Transforms the Insurance Industry

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Experts in health informatics are becoming an integral part of the insurance industry as more insurers work with health-care providers to find cost-effective ways to enhance the quality and safety of patient care.

The Affordable Care Act has led to changes in the delivery and reimbursement of health-care services, prompting health care systems, health care providers, and insurance companies to work together to improve patient outcomes and the bottom line.

With the advent of electronic medical records, health-care providers have been turning to health informatics professionals to manage sophisticated health information systems. Insurers also are using informatics to help health-care providers enhance the quality of patient care while simultaneously reducing costs.1

Today, insurance companies rely on health informatics experts who are adept at analyzing medical data to spot emerging trends, to improve health literacy, reduce hospital readmissions and visits to the emergency room, and help individuals prevent and manage chronic and costly medical conditions.2

Labor experts expect the demand for a well-trained health informatics workforce to grow, and those holding an advanced degree are likely to have their pick of jobs. A Burning Glass Technologies analysis3 of job postings nationwide showed that health informatics jobs remain open longer than many others because of a shortage of candidates. Informatics positions constitute the eighth-largest share4 of health-care occupation postings.

The role of Big Data

The field of health informatics is at the crossroad of where health care meets information technology. Experts in this field are involved in the collection, managing, and processing of clinical and medical information. With their keen analytical skills, health informatics professionals turn data into useful information that can ultimately lead to improved clinical outcomes at a lower cost to patients, providers, and insurers.5

Insurance companies have access to a treasure trove of health data gleaned from policyholders’ billing claims, health assessments, wellness programs, lab readings, medications, family history, and more. Insurers can run computer algorithms on huge amounts of health data to better understand the health needs of their members, including identifying gaps in care plans to optimize patient care.

Building healthy communities

For example, insurers can use data to identify and assist individuals who are at risk of developing chronic and costly diseases before symptoms appear. This information can be used by health-care providers to develop patient education and wellness programs to keep people healthy.6

In addition, health informatics experts can use data to identify individuals who have a chronic illness and need help to avoid serious consequences. For example, educating diabetics on the importance of visiting their primary care provider for periodic foot checks is a cost-effective way to reduce the number of diabetics who need costly amputations and rehabilitation because their disease has progressed.

Avoiding hospital readmissions

With the cost of preventable hospital readmissions totaling $17 billion annually,7 the federal government launched an initiative that penalizes hospitals that have avoidable readmissions. Some insurers are using health informatics to identify and connect frail or sick patients who are likely to be hospitalized with free health coaches.8 These coaches can help patients by coordinating care, providing transportation to medical appointments, and resolving medication issues – all with the goal of keeping people healthy and out of the hospital.

To learn more about the booming field of health informatics, check out The University of Scranton’s online Master of Science in Health Informatics program. The interdisciplinary program offers students the knowledge and leadership skills needed to succeed in this emerging field.


1-2 & 5-6: PWC. Advancing healthcare informatics: The power of partnerships, 2016, Accessed 23 August 2016.





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