No Analysts Needed

Health plans continue to face operational delays caused by fragmented systems and over-reliance on manual reporting cycles. While data analysts work across multiple platforms to produce static reports, the insights often arrive too late to support real-time decisions. This episode explores why traditional models are no longer sustainable—and how self-service dashboards, powered by a connected data ecosystem, are transforming operational agility. Listeners will hear how prebuilt metrics offer immediate visibility across functions like claims, call center performance, and ID card fulfillment, helping teams respond faster, stay compliant, and improve member outcomes. The discussion also covers adoption strategies, ROI considerations, and the organizational shift toward on-demand, decision-ready data.

Listen now to discover how leading health plans are moving from reactive operations to real-time insight, without relying on analysts.

Host: Today, we’re examining a key operational challenge: the over-reliance on data analysts and manual reporting to access operational data needed for day-to-day decision-making. In this episode, we’ll unpack why the traditional model of data access in health plans is no longer sustainable—and how self-service dashboards and real-time decision-making are the future.

Joining us today is Michael Waxman, a health plan operations leader with more than 20 years of experience as a health payer consultant at PwC and EY. He recently served as the Director of Business Operations for a Medicare Advantage client who implemented HealthProof’s technology ecosystem. Using HealthProof’s self-service dashboard, he ensured operational alignment for the health plan’s provider data, claims, credentialing, cross-functional alignment for call center, disputes, utilization management, and more. Today, Michael is a member of the Advisory Services team at HealthProof. Michael, thanks for being with us today.  

Michael: I’m thrilled to discuss this topic, and I’m grateful I can do this work to advance healthcare operations by making critical data available to make real-time decisions.  

Host: To start, can you share what you’re seeing in the industry today when it comes to the accessibility—or inaccessibility—of operational data?

Michael: Absolutely. One of the most persistent issues across the payer industry is data fragmentation. Operations leaders manage dozens of interdependent workflows—claims, enrollment, appeals, call centers, ID card fulfillment—but the underlying data for each of those processes often live in separate systems, in varying formats, and with inconsistent update cycles.

That creates a reactive environment. Executives and managers are forced to make decisions based on historical data, often compiled by analysts days or even weeks after an event. This introduces lag, uncertainty, and missed opportunities to course-correct.

Host: That’s a critical point, and it’s something we hear from many health plans. They’re operating with a delay and constantly playing catch-up. From what you’ve seen in your career,  what’s at stake when organizations don’t have timely access to their data?

Michael: The stakes are high. Gaining insights from operational data used to be, and still is for a lot of plans, a manual, time-consuming process. Analysts have to pull the raw data from multiple systems, then spend hours, sometimes days, cleaning and transforming it before building custom pivot tables, charts, and graphs to extract meaning. Each report is essentially a one-off project, requiring a clear request and requirements, technical know-how, and cycles of back-and-forth refinement. By the time a decision-maker receives the final output, the data is often outdated or is missing critical context.

For example, let’s say you’ve got a health plan getting flagged on CMS audits. You know, CMS has strict requirements about timeliness for ID cards. Maybe the problem isn’t the plan’s fulfillment process. Maybe it’s because they have no visibility into when cards are being generated, mailed, or delivered. It’s not unusual for compliance teams to request data to support a corrective plan, but the IT department needs several business days just to pull the numbers. By the time they have the information, the issue has already escalated.  

In this case, as in many cases, the operational leaders can’t rely on static reporting cycles. They need real-time, self-service access to key metrics to lead effectively and stay compliant.

The objective is developing useful and real-time information that aligns to the business objectives.

Host: Many plans have tried to build more robust reporting mechanisms, but they still lack timely data access. In your view, what is the barrier to accessing this operational data?

Michael: Yes, I’ve seen that—where the plan starts using a dashboard that promises operational data in a usable format, but then it still doesn’t quite deliver. That’s why plans have to evaluate their entire technology ecosystem with a holistic lens. They can’t just get the supposed best system for this or that, or get a reporting dashboard, and expect operations to run smoothly. The missing link is that the data is siloed and stuck in separate systems. A dashboard is only as good as the data that feeds it.

The ecosystem model begins by consolidating your data into a structured platform, like an operational data store. Only then, can you democratize access to that data through self-service dashboards that don’t require deep technical expertise to use. So now, you’ve got free-flowing data that informs the dashboard. That’s step one. Step two is the dashboard has to provide meaningful information. It has to be structured in a way that is useful to its stakeholders. Like HealthProof’s self-service platform is user-friendly and has prebuilt metrics, so the information needed for day-to-day decision-making is accessible and near real-time.

Host: Can you give me something to visualize? What do these pre-built metrics look like, and what are they used for?

Michael: Yeah, that's a good question. We have lots of different operational areas where managers can log in and instantly see the status of their domain with ready-to-use visualizations in areas like claims, enrollment, call center performance, ID card aging, and more.  

If you’re a claims manager, you’re going to want to see things like total claims, new versus adjusted, auto-adjudicated versus manual, EDI versus paper, and the status of each—whether it’s pending, needs review, or is finalized. Now, you can identify where work is piling up or which SLA thresholds are at risk.

Managers receive alerts when thresholds are approaching risk, so they can reallocate staff or escalate issues. This proactive posture reduces compliance risk and improves member and provider satisfaction. So, whatever the area of operations, having prebuilt metrics and ad-hoc reporting tools at your fingertips frees you from routing requests through a reporting team. That shift from “pull and wait” to “log in and act” is transformational for health plans.

Host: For executives listening, who might be evaluating investments in self-service dashboards, how should they assess the ROI on this kind of platform?

Michael: For sure. Off the top of my head, the return comes from three angles. First, operational efficiency. With real-time visibility, you can reduce redundant work, eliminate backlogs faster, and improve productivity without necessarily increasing headcount. Then, there’s the benefit of compliance and audit readiness. Meeting CMS timelines for ID card delivery, resolving grievances, or responding to appeals becomes more manageable when the data is visible in a format that makes sense. Third, things like delays in claims or ID card delivery directly affect member satisfaction and retention. The ability to track and address those issues in real-time has a real impact on member experience.

Host: Let’s talk briefly about adoption. In your experience, how do you ensure these tools are actually used—and not just another layer of operations that sits idle?

Michael: The key is usability. The platform needs to be intuitive enough for non-technical managers to use it daily. That means clear visuals, logical navigation, and the ability to compare multiple data points side-by-side—like claims status, call center activity, and ID card aging—all in one view.

I’ve seen adoption happen quickly because users see immediate value. They log in and see answers to questions they would otherwise be emailing someone about. That kind of impact builds trust in the tool and accelerates adoption.

Host: Before we close, what advice would you give to health plan leaders who are just beginning to evaluate a move to support their operations with real-time, self-service data?

Michael: An important first step is to identify the data siloes in your organization. Ask yourself, “Could a connected ecosystem—where the same data informs all systems make operations easier?” The second step is to identify the areas of operations where you are waiting days or weeks for clarity. How much easier would it be if your operational managers could log in, on-demand, and access the information they need for day-to-day decisions? If you answered yes to those questions, then you should consider exploring HealthProof’s ecosystem, which features a consolidated data hub and self-service dashboard. The ultimate goal is to minimize friction and create an environment where every manager has the necessary tools to lead with precision. This makes for a happier workforce and a more efficient organization. I believe the industry has no choice but to move in this direction. As an industry, we cannot continue to operate out of silos. This is the most logical path forward.  

Host: Thank you. That’s a thoughtful framework—and one that’s extremely relevant for health plans looking to modernize their operational structure.

If you’re a health plan leader and would like to learn more about how your organization can modernize its data operations, visit Healthproof’s website to explore strategies, insights, and case studies. And, if you liked this episode, follow on Apple or Spotify and share it with your colleagues on LinkedIn.