Payers Are Interested In Supporting New Models, But Aren’t Ready

The new HealthEdge State of The Payer survey results revealed that although there is a continued strong interest from payers related to supporting new healthcare business models, the number of people that are ready to support these new models is still lagging.

Although this survey is still open to responses, 100 healthcare payer IT executives already weighed in. The survey respondents selected Medicare and Medicaid expansions, Pay-for-Performance (P4P) and Accountable Care Organizations (ACOs) as the top three models that they are planning to participate in or support over the next three years.

The results showed that respondents are largely ready to support P4P (74 percent), ACOs (52 percent) and Value-Based Benefit Designs (VBBDs) (48 percent). However, only 39.5 percent are ready to support Next-Generation Consumer-Directed Healthcare Plans (CDHPs) and only 46 percent are ready for other models involving new payment approaches.

“As a result, many payers are supporting the models using additional manual processing, which is not a long-term strategy for success. Manual processing continues to increase, particularly as payers try to do things that their legacy administrative platforms were not built to handle,” said Ray Desrochers, executive vice president of sales and marketing at HealthEdge.

Manual processing is very expensive, which only adds to the already strained budget restraints that healthcare CIOs are facing day-to-day. Approximately 61 percent of the survey respondents are paying $6 or more to adjudicate a single claim manually.

Desrochers also commented that HealthEdge is seeing strong payer interest in the pursuit of the individual market on their own versus just through the exchanges. More than 50 percent of the respondents plan to offer products to consumers, with another 14 percent on the fence. This is good news for healthcare solution providers looking to enter the payer market this year and offer these IT executives an in-house data storage solution.

In addition, the survey respondents are overwhelmingly looking at mobile tools to help make connections among payers and members, with 83 percent of the respondents planning to leverage mobile tools for members and 62 percent planning to leverage them for providers.

“There is considerable interest in finding new ways to connect and communicate with everyone involved in the healthcare delivery cycle, and particularly in finding new ways to better link the payers and the members,” Desrochers said.

With the planned adoption of the new care-delivery models, manual processing and mobile tools, new technology will be needed to fill in the gaps that legacy infrastructures will expose. Furthermore, more than half of the respondents are looking to improve internal and external transparency and seek to leverage new technology to do just that. Healthcare CIOs are on the right track, and it is a good time to be an IT vendor in the healthcare space right now.