Contributor: Don Canning
I’ve read countless papers on the impact of healthcare reform on the insurance industry, but I have found few that are looking at these changes from the perspective of how these mandates will impact healthcare payers – particularly, technology, people and processes.
First, let’s take a look some of the challenges. Insurance companies offering health plans either directly, through employers, and/or governmental healthcare programs must address, in whole or part, all of the reform provisions and mandates. Status quo is no longer sustainable for healthcare payers to prepare for dynamic regulatory reforms across public and private plans.
Health insurers have new opportunities to look beyond current financial incentives and get more aggressive about quality, costs and waste. Employers’ satisfaction with their health insurers has eroded during the past several years, however health insurers can respond by providing more value through better information management.
According to PWC’s paper: What Employers Want from Health Insurers in 2010, “Satisfaction by large employers decreased by an average of five percentage points, from 64% in 2008 to 59% in 2009, while satisfaction among small employers held steady”. While the NAIC and 34 states currently have minimum Medical Loss Ratio (MLR) guidelines for insurance companies, few are as stringent as the national standards established in the Affordable Care Act legislation. Existing state-specific minimum MLR guidelines range between 50% and 85%, with most falling between 60% and 75%.
I believe that the changes payers now face will require strong maintenance and consistent monitoring to maintain employer satisfaction across claims accuracy, timeliness, fees, online payments, eligibility, discounts and analytical reporting capabilities.
It’s my opinion that insurers that understand the implications to healthcare payer information technology systems can turn reform mandates into a competitive advantage.
Several healthcare payers are testing innovative new technology and business models that deliver not only business process management (BPM) operational efficiencies but also task-level workflow analytics for compliance reporting. The most innovative, proactive payers will lead the industry to new business models promoting new programs, services and technology that address health care reform phases to help raise employers’ satisfaction with insurer services while managing Medical Loss Ratios (MLR).
Insurers can leverage the impact of reforms to evaluate and determine clear, relevant outcomes to elevate importance and satisfaction on performance guarantees, and health risk profiles. This is an opportunity for employers to value programs and services that increase satisfaction, targeting performance guarantees, wellness programs, disease management, personal health records and online comparison tools.
SunGard iWorks Healthcare Resources
Thought Leadership:
- To learn more about SunGard’s view of the reform landscape and better understand how insurers can prepare to comply with these critical mandates, download our paper: Rethink Process Excellence to Visualize New Programs
- For a look at the impact of healthcare reform on employees, employers, products and distribution channels – and insight into what it takes to succeed in this environment – read Stu Rubenstein’s report,The Impact of Healthcare Reform.
Awards:
- SunGard Technology Takes Top Honors – SunGard was among the winners of the prestigious Innovation Awards bestowed at the 2010 Healthcare IT Summit, taking top honors in the category of Best New Payer Technology. The award winners – selected by senior IT executives and decision makers who attended the November summit – represent vendors with the most exceptional and relevant healthcare IT solutions.
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