The market for healthcare IT is predicted to expand even more than it already has, the consumer/customer relationship should improve, and the payer and provider markets are becoming intertwined. We had the opportunity to interview Janice Young, program director for Payer IT Strategies at IDC Insights. She weighed in on these issues as we discussed her role in healthcare IT, her reflection on 2011 and what she sees coming in 2012.
HCITS: What is your role in healthcare IT?
Young: I am a technology analyst for the healthcare payer insurance market. We look at business evolution in the marketplace and then we assess and advise our clients on the technologies that may be best suited to help them be successful both in the current marketplace and in the future as the market evolves. Obviously, in the world of healthcare reform in the U.S. right now, there is an extremely rapid evolution of market and business dynamics, and technology follows very closely behind that. So we provide strategic assessments and direction as well as assessment of particular types of technology and how they can be deployed and used most effectively.
We do essentially a “hype cycle” analysis to identify when a technology might be new and when it might be ready for broader use in the industry, when it is being tested, when its cycle has come to an end and when new technologies will be acquired in its place. We talk about business strategies of how to do that.
HCITS: In your opinion, what is happening on the payer side that is truly impacting the provider side?
Young: Especially in the U.S., the payer and provider markets are becoming more and more intertwined. One of the main focal points includes the evolution and introduction of accountable care organizations and medical help, where healthcare plans are shifting risk to providers for responsibility for both financing and care of individual members and, simultaneously, health plans are beginning to acquire technologies, if not provider organizations as well, to develop their own accountable care organizations. In the U.S., the notion of who manages the insurance risk and what entity provides the actual care is becoming a little bit more ambiguous between health plans and provider organizations. I see a lot of investments in health plans in provider technologies, and I see a lot of investments in technology organizations that traditionally have focused on the healthcare payer marketplace.
HCITS: What technologies were hot in 2011? What is your insight for 2012?
Young: The most significant technology investments in 2011 in the healthcare payer marketplace are generally focused on business intelligence strategies and care management. When we polled our healthcare payer audience in late 2010, the top investment categories were in three specific areas, all of which link directly to reform mandates and initiatives. The first investment strategy was the finance consumer sales strategy and the investment and analytics to understand more about consumer investment in solutions and tools that one can deploy in a portal environment to enable a consumer to choose and select benefit plans and to improve the sales process. The other two categories that were even more widely adopted and of higher priority than the consumer focus were healthcare business intelligence/analytics tools and health and care management technologies and solutions. In order: one, business intelligence; two, health care management; and three, automated consumer sales and solution tools.
HCITS: Based on your prediction for 2011 that healthcare payers will increase investment in and acquisition of technologies, do you think this has occurred thus far?
Young: I do. Heath plans have certainly invested a lot in the three categories I just pointed out and there is clear and continual investment—and a lot of activity—in the health plan arena in health management strategies and business intelligence and analytics, without question. We are also hearing, as we come to the end of 2011, there will be some additional investment in provider technologies and some movement toward the finance side, or the provider side, and provider revenue cycle management solutions as well.
One of the underlying assumptions around the predictions of increased investment in technology is that health brands have deadlines for healthcare reformat that they have to comply with for medical loss ratio as well as other features. And, for any sort of player in the accountable care organization market, now is the time to invest in and deploy those technologies and even provider assessments as well. It is a very hot topic; the technology sector for healthcare in the U.S. is probably one of the hottest employment areas and we can see that it is a very feeble job market, so there is lots of investment and lots of activity. The final thing that we should mention is that there is an ICD-10 mandate coming in the next year as well so health plans need to continue to invest to demonstrate that they are complying with the ICD-10 mandate. Over 60 percent to 70 percent of health plans that we surveyed said they would be increasing their technology investment in 2011 and, given all of the mandates, it may be even higher than that.
HCITS: What do you expect in 2012 around consumer/customer relationship management?
Young:
What we expect in 2012 around consumer/customer relationship management is the following trends. The first is increased automation and investment in portal solutions so consumers can go into a portal to look at benefits, to select benefits, to have automated enrollment. So, first is the investment in the general automation of the customer relationship management process and to integrate various process steps including some of the financial aspects of enrolling and then paying for being in a health plan—the billing process and the rest. That’s pretty fundamentally strictly defined consumer/customer relationship management capabilities. So, there is a lot to do in healthcare—a lot of automation, a lot of investment that could still take place to improve both independent processes and the integration of those processes.
Secondly, we expect investment in health plans to understand more about consumer dynamics as they enroll—the application of technologies that have been used in retail markets and financial services markets to understand what types of consumers enroll in particular products, how best to reach out to them, what types of triggers and additional information we should provide at the point of sale at the end of the automated process, etc.
Thirdly, the additional linkage point for customer relationship management will be moving into integrating with health and wellness and care management aspects. As we know, if you catch a human earlier in the disease process or before the human gets sick, you can avoid cost of care, cost of illness, cost of services—so, the idea is once upon enrollment to know more about the individual customer or consumer and be able to present them with health and wellness, or care services, that are appropriate and will drive toward improved outcomes and reduce illness.
So, the three things to expect are: one, creating a better automated process, which other retail and financial services banks have succeeded at; two. creating more integration around care and health earlier on in the process to learn what the consumer market requires and how to move solutions more rapidly; and three,using analytics to understand the sales process and also consumer behavior as you present options for health and wellness and disease avoidance. So, those three are the integration parts that we see with CRM.
HCITS: What are the top two things that you get from the Healthcare IT Summit? Why do you feel people should attend the event?
Young: The top reason to go to the Healthcare IT Summit is the opportunity to speak to peer organizations and to create some friends and some industry contacts and collaboration around the challenges that we all face in the industry. It creates a good opportunity to understand, share and talk about the best practices and solutions that you might be facing in your own environment; the discussions are good.
The second reason is for the content; the event has really nice content, which can provide both the current-day solutions and challenges and a road map into future environments. The content is a way to both understand how to solve current tactical problems as well as to get your intellectual business juices flowing so that you begin to look a little further down the road and understand that what you are doing today needs to fit into other decisions that you will be making next year. We know that it is a rapidly changing market, and it is more important to have a strong handle on your tactical decisions as well as really continuing discussions on where the future will go and what opportunities you might want to take advantage of and how your current-day technology or business decisions affect what you might want to do in the long term—maintaining flexibility and improving your ability to remain agile and adaptive. A lot of shared insights can be helpful for developing both that business and technology strategy.
