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.
