Technology and Data Drives Payers to Play a More Integrated Role in Healthcare

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Can you imagine a future where health plans are aligned with care delivery teams to enable consumer-centric care models? Deloitte suggests that, by 2040, payers will likely play a much more integrated role in healthcare with technology driving the needed shift from disparate systems to a connected future. Health plans are expected to look beyond claims payment and begin to help drive a data revolution where digital technologies will support reducing the cost of care, streamlining processes, and achieving better outcomes through population health initiatives.

Health Insurance Data Helps Drive Current Preventative and Wellness Programs

While a truly connected healthcare technology network may be years in the future, there are numerous health insurance sponsored initiatives already taking place around the country. Their goal is to use health data to drive program development and aim to reduce overall program costs. These efforts are evidence that more progressive programs and more advanced technology tools are just down the road.

A recent survey indicates that  42% of payers are adding community programs and resources to their population health efforts, while 34% said they use census and socioeconomic data along with clinical data to create new programs. These types of services point toward positive long-term health outcomes for participants along with the reduction of long-term healthcare claims and other expenses. Recent demonstrations include:

  • Suicide Prevention – Suicides fell 67% in three months during a 2016 Magellan Health effort with Medicaid patients in Arizona. The program included behavioral health screenings and faster referrals to mental health services. It also addressed other important issues like poverty, food and housing insecurity, and environmental exposures such as homes with lead paint.
  • Humana’s Bold GoalA multi-faceted program from Humana seeks to improve the overall health, and in turn the number of quantifiable healthy days, of the communities it serves by 20% by 2020. The insurance company partners with physicians and community agencies in more than 15 cities with innovative programs that address food insecurity, loneliness and social isolation.

Since research reports that 80% of health outcomes are caused by factors unrelated to better healthcare, it makes sense that our eating and exercise habits, socioeconomic status, and where we live could have a greater impact on health status than the quality of medical care received. That means that insurance companies have an important role in expanding opportunities for people to improve their health, which can also help lower future medical claims and burdens on the system.

The goal here is a win-win.

Like providers, payers face cybersecurity, interoperability and record retention challenges

As health insurance companies continue to grow their role within the industry and their relationships with patients, they also face the tough challenges of cybersecurity and increasing interoperability requirements. Add in record retention mandates and other data management needs, and it’s clear that payers have a lot of balls in the air.

On the cybersecurity front, one of the largest cyberattacks in recent history was the 2015 massive attack against Anthem where an estimated 78.8 million consumer records were exposed. This event, which is thought to have ties to a foreign government, was made possible by one unsuspecting user at Anthem who opened a phishing email which gave the hacker access to Anthem’s data warehouse. Cybersecurity issues continue to plague the entire healthcare landscape and payers aren’t immune.

In terms of interoperability, there are gaps in the availability and transparency of information shared between providers, payers and patients. Providers often struggle to know the level of coverage and copay at point of care. Payers aren’t always able to use coverage determinations to help guide care to better quality or lower cost options, which requires payers to spend even more on process and staffing. Patients remain unsure whether treatments are covered and what their out-of-pocket cost will be.

In general, payers are required to manage vast amounts of data according to HIPAA privacy and security regulations. They also need to retain records of claims and appeals for six years. Insurance records, like health records, are governed on a state by state basis and regulated by specific state retention requirements.

Near-Term Technology Moves for Health Insurance Companies

While the future 2040 vision of the truly connected healthcare landscape may still be years in the making, there are steps payers can take now. The Deloitte article previously mentioned suggests that in the next three to five years, there are two types of opportunities for health plans to manage data more efficiently:

  • Coordinating the data and processes with an enterprise-wide strategy
  • Automating aspects of data collection and reporting using tools like robotic process automation (RPA), natural language processing, and artificial intelligence (AI)

As the top data extraction and migration healthcare IT company according to Black Book™ Rankings, our team is on the front lines helping to manage and secure health data to meet cybersecurity, interoperability and record retention best practices. Our data storage solutions support secure, vendor neutral, long-term access to data and provide workflows that fit enterprise-wide data management strategies.

With 90% of Americans currently covered by health insurance, there is a large amount of data that needs to be managed by the HMOs, group health plans, Medicare and Medicaid organizations.

Does your payer organization have the data management strategy it needs in place?

For Payers looking for a reliable partner to help securely and successfully extract, migrate or  store data, we’re ready to get started.

Aug 19 2019

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