The Gap Between Health Plan Insights and Action
At Lilac, we spend a lot of time talking to health plan leaders about their biggest operational challenges. The conversations often start the same way: “We invest all this time and money into reporting, we have the data to tell us what’s happening, but by the time we act on it, it’s too late.” This disconnect between insight and action isn’t just frustrating—it’s costly. Plans miss quality improvement opportunities, members don’t get the care they need, and administrative costs spiral as teams scramble to manually respond to issues that could have been prevented.
The Reality of Manual Intervention Today
Let me paint a picture that will sound familiar to anyone working in health plan operations. Your analytics team or platform flags 300 members who need diabetic eye exams to improve your HEDIS scores. What happens next?
Someone exports a list, coordinates with care management, manually segments members by risk factors, sends generic outreach messages, tracks who responds, follows up on non-responders, and escalates complex cases. The entire process takes weeks, involves multiple handoffs, and often loses momentum before meaningful interventions occur.
The problem often isn’t lack of insights—it’s the manual orchestration required to turn those insights into action. By the time the intervention is deployed, the data is stale, opportunities are missed, and your team is already fighting the next fire.
Why Traditional Analytics Fall Short
Transitional analytics platforms are invaluable for their ability to generate clear dashboards and reports. They empower us to visualize trends and make informed strategic decisions and pinpoint outliers. These tools are crucial for understanding what data is telling us.
The challenge, however, is in translating insights into actions. There are several common critical challenges:
Speed: Manual processes are slow to unfold. By the time interventions reach members, the window for optimal impact has often closed.
Consistency: Typical workflows vary in quality and completeness. Some members get comprehensive outreach, others fall through the cracks.
Scale: Even the best teams can only handle a fraction of all the cases they need to.
Cost: The labor required to manually orchestrate interventions is expensive and doesn’t scale with increasing complexity and plan growth.
The Cost of Delayed Action
When plans can’t act quickly on insights, the consequences compound. A member who misses a diabetic eye exam in Q1 becomes a bigger risk by Q4. A medication adherence gap that could have been resolved with a simple reminder call becomes a hospitalization. Cost outliers that could have been addressed early become major financial drains.
The most successful health plans we work with have recognized this fundamental challenge: having good data is only half the equation. The other half is having the capability to act on that data at speed and scale.
This is where a new category of technology is creating fundamental change in how health plans operate. But before we dive into solutions, it’s important to understand exactly what we mean when we talk about moving from reactive to proactive operations.
In our next article, we’ll explore how agentic AI systems are bridging this gap by automating the complex orchestration required to turn insights into action—and why this represents a fundamental shift in how health plans can compete.
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Lilac Software is building predictive analytics and agentic AI solutions to help health plans move from reactive to proactive operations. If you’re interested in learning how our platform can help your plan generate action critical insights faster, reach out here to start a conversation with the Lilac team.
