Understanding the use of patient-reported data by health care insurers: A scoping review

Abstract

Background Patient-reported data are widely used for many purposes by different actors within a health system. However, little is known about the use of such data by health insurers. Our study aims to map the evidence on the use of patient-reported data by health insurers; to explore how collected patient-reported data are utilized; and to elucidate the motives of why patient-reported data are collected by health insurers. Methods The study design is that of a scoping review. In total, 11 databases were searched on. Relevant grey literature was identified through online searches, reference mining and recommendations from experts. Forty-two documents were included. We synthesized the evidence on the uses of patient-reported data by insurers following a structure-process-outcome approach; we also mapped the use and function of those data by a health insurer. Results Health insurers use patient-reported data for assurance and improvement of quality of care and value-based health care. The patient-reported data most often collected are those of outcomes, experiences and satisfaction measures; structure indicators are used to a lesser extent and often combined with process indicators. These data are mainly used for the purposes of procurement and purchasing of services, quality assurance, improvement and reporting, and strengthening the involvement of insured people. Conclusions The breadth to which insurers use patient-reported data in their business models varies greatly. Some hindering factors to the uptake of such data are the varying and overlapping terminology in use in the field and the limited involvement of insured people in a health insurer’s business. Health insurers are advised to be more explicit in regard to the role they want to play within the health system and society at large, and accommodate implications for the use of patient-reported data accordingly.

Improving Outcome-Driven Care in Multiple Myeloma Using Patient-Reported Outcomes: A Qualitative Evaluation Study

“…This information will support decision making on whether treatments should be reimbursed in health insurance plans. However, health insurers lack interest in PROs and outcome-driven payment [ 41 , 42 ]. Transparency on which treatments provide the highest value for patients becomes increasingly important especially in patients with MM, owing to the introduction of expensive new and prolonged treatments.…”

Citizen engagement in healthcare procurement decision-making by healthcare insurers: recent experiences in the Netherlands

“…The current health information landscape is not sufficiently robust to support healthcare insurers in operationalizing care procurement policies anchored in people-centred value-based principles. Aside from the healthcare insurers’ poor availability of care quality and outcome data (notably, PROMs and PREMs) [ 12 ], unclear regulation about data custodianship hampers a greater use of intelligence towards supporting value creation. It is not clear which data each actor in the system should have access to and what the value chain of data could be like.…”

“…The meeting was structured in two parts. First, to contextualize the study, ÓBF shared conclusions of the scoping review performed earlier by members of this research group on the use of patient-reported data by healthcare insurers [ 12 ]. Secondly, NK moderated the discussion around four discussion statements drawn from phase 1 of the study (these were displayed in both English and Dutch) while ÓBF, VB, and DK took notes (Additional file 3 ).…”

“…Healthcare insurers have a unique position to serve patients in their healthcare needs and support the broader population in accessing people-centred value-based healthcare services. In fulfilling their function of procuring people-centred value-based healthcare services, healthcare insurers are developing their data strategies to gain insights into value creation from the citizens’ perspective, notably by collecting people-reported data [ 12 ]. Yet, there is a chasm between the data healthcare insurers collect from the insured and how data are used towards realizing people-centred value-based healthcare, as highlighted by a scoping review conducted by members of this research group [ 12 ].…”

“…Healthcare insurers have been operationalizing several applications of citizen engagement (e.g. by conducting surveys and focus groups) and using intelligence derived from these applications for ensuring and improving care quality and bolstering the value-based healthcare agenda [ 12 ]. However, the extent to which these applications of citizen engagement serve a tokenistic function in the relationship between healthcare insurers and citizens (including insurees) remains overlooked.…”