A recent survey revealed that 84% of HR and benefits leaders report satisfaction with their medical management reporting. Yet, less than half receive the full scope of data needed to drive real change. This disconnect highlights an issue many are not aware of: Satisfaction with reporting does not necessarily translate into effectiveness. Without comprehensive, actionable data, organizations may unknowingly create more problems by failing to manage costs, not improving member outcomes, or meeting compliance standards.
The illusion of "good enough"
Organizations often feel confident in their reporting because they access data with regular updates. This creates a false sense of security. Metrics may appear stable, but organizations and their advisors fail to see what is happening behind the numbers without getting deeper insights. Leaders reviewing standard reports assume they are well-informed, yet because they remain unaware of the full scope of data, this impacts their decision-making. When data lacks specificity, timeliness and usability, organizations miss opportunities to intervene early. Costs escalate, interventions are delayed, gaps in care aren’t fully explored, and they cannot adjust strategies to prevent financial losses.
Inadequate reporting and exploration of the results means missing trends that lead to preventable financial strain. Delays in utilization data prevent timely interventions. The inability to proactively address care gaps or inappropriate denials increases provider frustration and member dissatisfaction. Organizations relying on surface-level metrics struggle to identify inefficiencies that diminish the effectiveness of their medical management strategies.
Data-driven realities: What’s actually happening
Organizations must examine key operational data points to assess the effectiveness of medical management reporting. Prior authorization processing times provide a quantifiable measure of efficiency. Delays extending beyond the required window lead to poor member experience and may cause a delay in care. High authorization volumes with unclear criteria introduce inefficiencies, creating barriers for members and confusion for providers. Elevated appeal rates often signal breakdowns in provider responsiveness.
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Bridging the gap: What effective reporting should look like
Organizations must demand more from their reporting, shifting from accepting what they receive to asking for must-have metrics to monitor performance and drive strategic decisions. Focusing on insights directly tied to business and clinical objectives, like denial reasons and appeal outcomes, clarifies process inefficiencies and policy misalignments. Tracking high-cost claimants with utilization trends allows for better resource allocation and intervention planning. Identifying preventive care gaps and chronic condition management issues strengthens overall healthcare strategies.
Benefits advisors and employers can’t overlook vendor performance and alignment with organizational goals. Vendor reports should contain the must-have metrics. Require all vendors to surface risks and opportunities proactively, rather than waiting for the organization to identify problems. Their reports must facilitate alignment between clinical and financial stakeholders so decision-making reflects cost efficiency and member wellbeing. Organizations that evaluate vendors through this lens gain an upper hand in strategic planning.
Decision-makers who integrate effective reporting principles into their reporting structures gain a clearer understanding of risks, inefficiencies, and opportunities for improvement. Effective reporting aligns with fiduciary and clinical goals by tying key metrics to health plan objectives. Data helps guide policy changes and enhances care navigation efforts rather than only presenting retrospective insights. Reporting needs to be used as a proactive tool to shape active health care strategies rather than be treated as a passive compliance requirement.
Redefining satisfaction through insight
Satisfaction with reporting isn't enough. Organizations and their advisors need more than contentment; they need effective, actionable data that leads to better decision-making. Reporting should not merely meet the basic requirements, but uncover insights that drive improvements. As leaders, it’s essential to reevaluate your current reporting. Don’t just accept what’s presented. Ask yourself: What could these reports be delivering? Are they giving you the depth, clarity and timeliness to make informed decisions?
Take the time to audit your reports. Scrutinize the data for gaps and areas of improvement. Don’t wait until small inefficiencies snowball into bigger issues. Ask, “What am I missing?” Understanding this gap is the first step toward transforming your reporting from satisfactory to truly effective.
Mary Bacaj is President, Value-Based Care at Conifer Health Solutions.
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