From Clinical Intelligence to Insurance Impact: Redefining the Care Continuum
Catherine Hensley recently joined fellow healthcare leaders on a panel at the Becker's Conference to tackle one of the industry's most pressing challenges: closing the gap between what we know clinically about patients and how that intelligence actually shapes insurance design, benefits strategy, and care management.
We sat down with Catherine to share highlights from that conversation, in her own words.
To begin, could you share some details about your professional background and current organization?
I'll start with a quick personal story. Growing up, my mom worked in the pharmaceutical space, and I remember she would bring home these large binders of drug information. I was always excited when a new binder came home because that meant I could flip through the pages and do my best to try to understand the information.
That interest eventually led me into medication therapy management, where I was focused on supporting patients directly and really understanding the importance of a patient-centered approach, especially when navigating complex medications, chronic conditions, and gaps in care.
That experience gave me a strong foundation in how critical it is to meet patients where they are, not just clinically, but in how they engage with the healthcare system.
At MedWatchers, I've been able to build on that foundation in a broader way, looking at how clinical solutions and technology can help scale that same personalized approach across larger populations. We do that through a combination of digital tools and high-touch engagement, including call center support and more accessible, retail pharmacy models of care.
So my perspective is really about how we take those core principles of patient-centered care and extend them through technology, making care more connected, more proactive, and ultimately more impactful across the entire continuum.
The title of this panel, "From Clinical Intelligence to Insurance Impact," implies that clinical data and insights are not reaching their full potential within the insurance and payer ecosystem. Where is the disconnect between what we know clinically about patients and populations and how that intelligence translates into insurance design, benefits strategy, and care management?
I think the biggest disconnect isn't a lack of data. It's fragmentation in how that data is operationalized. Today, many payers rely on multiple vendors across different functions: one for care management, another for engagement, another for analytics. That creates inherently siloed channels. Each partner may generate valuable insights, but they're not always connected in a way that translates into cohesive benefit design or coordinated member experiences.
What we're seeing work better is a more unified approach, where a single platform or tightly integrated model can connect AI insights, clinical workflows, and member engagement. When you can do that end-to-end, you reduce that disconnect significantly because insights are immediately actionable, not just informative.
The concept of a "care continuum" assumes some degree of coordination and data flow across settings: primary care, specialty, behavioral health, post-acute, pharmacy. What is actually working to break down those silos, and where does the industry need to invest to make the care continuum a reality rather than a concept?
What's working today is a shift from viewing integration as simple data sharing to enabling real coordination across people, processes, and technology. Data alone doesn't create a care continuum. What does is a shared, real-time view of the patient that providers, plans, and care teams can act on. That's what reduces friction and makes care feel connected.
We're also seeing progress through omnichannel engagement, meeting patients where they are across digital, call center, and in-person retail pharmacy settings. That flexibility helps close gaps and keep patients engaged.
Where the industry still needs to invest is orchestration. Interoperability has improved, but moving data isn't enough. We need to activate it in real time across the care journey. That means integrating clinical, behavioral, and social data into unified workflows and aligning payer insights with provider action.
Ultimately, the care continuum becomes real when it's seamless for the patient, and that only happens when systems work together, not in silos.
We often talk about "closing the loop" in care management, but in reality, care is ongoing and interconnected. How should payers rethink the use of clinical data to support continuity rather than one-time resolution?
I think this really comes down to a mindset shift.
Historically, care management has been very focused on resolving a specific issue and then moving on. But the reality is, care is continuous, and every intervention is connected to what comes next. And this is exactly where AI and predictive analytics change the equation. Instead of surfacing a gap after it's already a problem, these tools can identify which members are trending toward a high-risk event before it happens, so payers can intervene earlier, with the right resource, at the right moment.
So instead of using clinical data to solve a single problem in a moment, payers need to use it to understand the full context of the patient's journey: what's already happened, what's happening now, and what's likely to happen next. That means using clinical data not just to identify gaps, but to guide ongoing engagement.
Because the goal isn't just to close the loop. It's to make sure each loop connects to the next. That's what really creates continuity.
Prior authorization has become one of the most contentious issues at the intersection of clinical intelligence and insurance operations. How should payers be rethinking prior authorization in the context of better clinical intelligence? Is there a path to a system that genuinely serves patients without sacrificing cost management?
The assumption is that loosening PA means losing cost control. But the evidence doesn't fully support that. A significant portion of PA denials get overturned on appeal, which means the cost of the service was incurred anyway, plus the administrative cost of the appeal process, plus the cost of the delay in care.
And there's always a concern that introducing AI could make care feel less personal. But in reality, when it's used the right way, it should do the opposite. It should reduce administrative burden and give providers more time to focus on the patient.
So I do think there's a path forward, one where prior authorization becomes less of a barrier and more of a support system that helps guide the right care at the right time, without losing the human element that's so critical to patient care.
If you could redesign the relationship between clinical intelligence and insurance decision-making from scratch, what would you change first?
I think the biggest change would be moving away from point-in-time decision-making toward a more longitudinal view of the patient. Right now, many insurance decisions are made based on a snapshot, a single request or moment in time, rather than the full context of a patient's journey. If we could redesign that, decisions would be informed by what's already happened, what's currently happening, and what's likely to come next. That's what would allow clinical intelligence to truly support continuity of care, rather than just isolated decisions.
If attendees remember just one thing from this conversation, what should it be?
If there's one thing I'd want everyone to take away, it's that care is not episodic. It's continuous.
In healthcare, we often talk about "closing the loop," closing a care gap or completing an intervention. And while that's important, it's never really the end of the patient's journey. There's always a next step, another need, or another point of engagement.
So the real shift is moving from closing loops to connecting them.
The themes Catherine raised, including fragmented data, the need for orchestration, and the shift from episodic to continuous care, are at the core of what MedWatchers is building toward every day. If you'd like to learn more about our approach to clinical intelligence and member engagement, click this link to speak with an expert.
