BOSTON, Aug. 25, 2025 (GLOBE NEWSWIRE) -- Arcadia® (arcadia.io), a leading healthcare data platform, today announced the publication of its latest research report, Scaling Smarter: The Data Strategies Powering High-Performing Health Plans. The report highlights a widening gap between the data capabilities today’s payers need and the tools, infrastructure, and analytics strategies many still lack. For example, without a unified data foundation built around complete member 360 profiles, efforts to apply agentic or generative AI will fall short, missing the savings and experience improvements these technologies promise.
The report also reveals how leading health plans are making meaningful progress with data-driven strategies that improve outcomes, manage costs, and strengthen provider performance. Key findings include:
- Data integration lags behind data sharing: While 66% of payers rated their ability to share data externally as “very good” or “excellent,” only 57% said the same about integrating data from external sources. In fact, 85% have yet to integrate all available data into a centralized analytics platform, which limits their ability to generate comprehensive and actionable insights.
- AI and advanced analytics are an untapped opportunity: Less than 20% of plans use AI to develop care plans, summarize records, or drive member engagement—tools that could improve operational efficiency and accelerate performance gains.
- Cost pressures drive strategy more than growth: Most payers prioritized cost-containment strategies, such as improving risk adjustment (54%) and optimizing network performance (50%), over revenue growth goals like expanding membership (45%).
- Member 360 profiles are common but incomplete: While 96% of payers said they maintain longitudinal member profiles, many admit challenges with data aggregation and interoperability. For example, 76% of payers surveyed aren’t fully realizing the value of social determinants of health data, 87% reported not using episode of care data, and just 10% of payers said they are actively using pharmacy data.
“Too often, payers believe they have a complete picture of the member, but our research suggests there are significant gaps in what data they’re actually using—meaning missed opportunities to unlock better risk adjustment, personalized care, and cost efficiencies,” said Michael Meucci, President and CEO of Arcadia. “A true 360-degree member profile must include timely and complete information across claims, clinical encounters, SDoH, episodes of care, and pharmacy data. When payers integrate that data and apply it strategically, they can improve outcomes, reduce costs, and collaborate more effectively with providers.”
According to the report, bridging the gap between fragmented data and actionable insight requires more than surface-level integration. Leading health plans are prioritizing platforms that unify clinical, claims, behavioral, and social data, which enables real-time intelligence that can be shared across care teams. With the right infrastructure, data shifts from a static asset to a strategic driver of transformation.
“The findings from this report make it clear that the most successful payer organizations will be those that invest in centralized analytics platforms, empower providers with shared insights, and apply data to personalize care, reduce costs, and improve outcomes,” said Luke Hansen, MD, MHS, Chief Medical Officer of Arcadia. “When payers and providers work from a common data foundation, it becomes possible to manage risk, optimize utilization, and enhance physician performance more efficiently.”
Download the full report, Scaling Smarter: The Data Strategies Powering High-Performing Health Plans, to learn how data-driven strategies are transforming payer performance, and visit Arcadia at RISE West booth #307 to continue the conversation.
About Arcadia
Arcadia helps providers, payers, and government organizations transform healthcare data into predictive insights that drive better outcomes, increase revenue, and reduce costs. Its industry-leading platform amasses data from across the healthcare ecosystem and converts it into actionable analytics, AI-driven intelligence, and performance benchmarks, enabling smarter decisions and accelerating impact across the enterprise. National and regional health systems and payers, along with governmental organizations – including Aetna, Highmark Blue Cross Blue Shield, Intermountain Health, Ochsner Health, and the State of California – trust Arcadia to operationalize their data and lead the way in data-driven healthcare. Visit arcadia.io for more information.
Arcadia® is a trademark of Arcadia Solutions, LLC. All rights reserved.
Drew Schaar Arcadia drew.schaar@arcadia.io
