The familiar refrains of healthcare industry disruption around cost control, consolidation, innovation and the shift to value-based care could be heard at last month’s Healthcare Information and Management Systems Society (HIMSS) annual conference, which brought together 1,300 companies and 45,000 attendees. With medical cost, operational cost and transformational cost efficiency remaining important for payers in an active regulatory environment, this year’s speakers touched on a range of opportunities for payers to create a positive human future for healthcare consumers including innovation, interoperability, artificial intelligence, blockchain and value-based care. The common thread in conversations was how to harness innovation and technology to make people’s lives better.
Based on our conference insights and wider experience, here are our five key learnings that help address the changing healthcare payer landscape…
Interoperability for payers is about ensuring there’s an integrated view of data across systems to drive proactive care delivery and better outcomes. This requires payers to connect and partner effectively with other entities across the entire healthcare ecosystem (such as hospitals, clinics and rehabilitation Centers). In its latest report on interoperability standards, the Office of the National Coordinator for Health IT (ONC) added more granular updates on added standards, updated characteristics, and additional information about interoperability needs. The more the industry can conform to a granular standard the easier it will be to achieve a fully integrated view and ultimately deliver better outcomes.
Payers have always been data-driven as the information they capture includes claims information and demographic information about their plan members. To stay ahead of the curve and ensure they have an operating model (including capabilities, processes and governance) which is resilient and responsive to frequent changing laws and data regulations (such as data privacy), payers need to re-evaluate their business models (including value proposition).
Integrating customer data to develop a single view of the customer and their universe is the foundation of any customer-centric business. How payers leverage insights from this information to deliver multi-channel member engagement strategies that enable better service or products (such as micro-insurance products for higher risk lifestyles) is key for member satisfaction, competitive advantage and business growth.
A blockchain is a distributed digital ledger/record of transactions that is gaining traction in healthcare. For payers, it can enable transparent determination of a payer’s contribution to a claim, automate activities around claims adjudication, and automate reconciliation of payment instructions for adjudicated claims. This provides faster settlement payment, reduced manual effort and waste and increased auditability of payment events.
Understanding the impact of social determinants on a member is critical to impacting and improving mental and physical health. For payers, leveraging data sets to understand the broader impactors on health, for example physical environment or economic stability, will be critical to improving the quality of care and healthcare costs. Designing care interventions which target not just medical symptoms but also these social determinants, such as health food vouchers or financial education, will improve the ability for payers to develop truly ‘whole’ person care plans.
HIMSS provided an opportunity for the healthcare IT community to come together and share experiences about industry challenges and opportunities. These five key learnings are critical for payers to forge a more positive human future for patients, and to stay ahead of a rapidly changing healthcare environment.