You are viewing all posts by, Roy Massie

Roy Massie

vice president of product management, SunGard's insurance business

2
May
2012

The healthcare data dilemma: The saga continues

Contributor: Roy Massie

Some time ago, I mentioned the overwhelming amount of data that we face in healthcare in my post - An e-Health Collage of Technology for Insurers. And though the popular media coverage still seems pretty distant from the reality in most health plans, transitioning to an e-Health environment is still top of mind for me. As health plans shift their focus from cost-cutting to growth initiatives, it is imperative for them to get a handle on their data. The data dilemma will only compound as the plan grows if there is not consistent data management infrastructure and governance for that ocean of privileged information coming in every day.... read more

Roy Massie

vice president of product management, SunGard's insurance business

29
Nov
2011

An e-Health collage of technology for insurers

Contributor: Roy Massie

Recently, the Department of Health and Human Services issued a rule that providers do not have to achieve meaningful use of Electronic Health Records in order to participate in an Accountable Care Organization. Providers have strong incentives to implement EHR, but they are not required in order to be in an ACO network. Along with their EHR incentives, providers have a lot of other technology hurdles in front of them (e.g. 5010/ICD-10). At my doctor’s office, I see some new information technology use at the front desk and occasionally in the exam room. But moreover, I still see rows and rows of color-coded paper folders holding patient records, stacks of folders in a daily queue and paper exchanging hands for receipts, scripts and other key transactions. In healthcare, as in most parts of our society, paper is an old and dying king, but it is still king.... read more

Roy Massie

vice president of product management, SunGard's insurance business

8
Nov
2011

Covering your assets…Over and over

Contributor: Roy Massie

Someone else may have minor surgery, but when it’s me, any surgery is major surgery… I think we can all relate to that feeling of a double standard when it comes to our personal health, or even our personal finances. And health plans are not immune to such thinking when it comes to their claims payments. Reviewing a payment decision over and over again can sometimes be more expensive than the actual value of a claim itself. The result – health plans often incur processing costs in excess of the value of the claim being reviewed. Though many know at some level that this yields a net loss, some insist on the comfort level such redundancies provide before any payment is made… regardless of its value.... read more

Roy Massie

vice president of product management, SunGard's insurance business

19
Aug
2011

Claims optimization: Redefining streamlining

Contributor: Roy Massie

The Duchess of Windsor once famously remarked that you can never be too rich or too thin. Based on conversations I’ve had with customers recently, I’d amend that to say you can never be too streamlined or too automated. At least that seems to be the case if you’re looking to optimize healthcare claim payment processes. These processes remain a constant favorite for additional streamlining and automation, especially in this era of healthcare reform and ICD-10. Our customers today are pursuing more-ambitious initiatives then we’ve ever seen – and we’ve been helping healthcare payers streamline claims for about twenty years.... read more