Healthcare Payers’ Top 5 Areas of Advancement, Opportunity
By - Healthcare payers are an imperative facet of the healthcare industry. As the ones paying for the care patients receive – often acting as insurance providers, insurance carriers, or health plan sponsors – payers sell health insurance to patients, then finance and reimburse providers for patients’ healthcare costs.
Here are five areas healthcare payers are continuing to focus on as means of their continued advancement and opportunity.
Payers are reassessing provider relations
A world where payers pay and providers provide is perhaps too outdated to remain viable. As the healthcare industry matures, healthcare providers are increasingly demanding their relationship with payers be less black and white and more like that of a business partner where collaborative communication and information sharing reigns.
Nonetheless, the notion of healthcare payers and providers working harmoniously together is perhaps a naïve notion, as it implies tremendous complexities and hearty organizational efforts to execute seamlessly. Reassessing how to best accomplish your own payer-related goals may be the key for ongoing success, even before a possible consideration of how to strengthen provider relationships begins.
Healthcare payer IT solutions are collectively focusing more on meeting upcoming revenue cycle demands as the number of patients continues to increase and ongoing demand for a financially economical and operationally efficient accounting and recording system advance, as RevCycleIntelligence.com reported. Growth in healthcare payer endeavors is projected to continue to remain eminent. The North American payer IT industry accounted for nearly 59 percent of the global healthcare payer IT market and it expected to grow by nearly 6 percent through 2018.
Payers look to investment opportunities
Another area of focus for healthcare payers lies in matters of investment and population health management concerns. Fifty-one percent of payers are manifesting new investment plans for care and disease management, stemming from widespread recognition of operational shift and the need to keep up, confirmed RevCycleIntelligence.com. Although data confirms many within the healthcare payment community claim they have a clear population health management approach firmly in place, such may be an industry-wide understatement where more attention is needed to address collective gaps.
Payers are updating payment methods
Healthcare payers are concerned about how payments are being made for public or private exchange plans, reported RevCycleIntelligence.com. Innovation loopholes abound as mobile adoption in the healthcare payer market is perhaps a tad behind the times. Benefits of upgrading with Apple Pay, for instance, include fraud reduction, protection of payment value chains, improved data security, and increasing credit and debt volumes for issuers and networks.
Payers seek transparency, financial gain
In relation to matters of population health, perhaps consider starting conversations about missed revenue opportunities or providing participation incentives to promote actionable dialogue between proactive parties. Private payers tend to outperform their public counterparts regarding performance levels. “The performance of payers plays just as important a role in determining the financial well-being of provider organizations, especially those with small or unique patient populations,” reported EHRIntelligence.com.
“Medicaid agencies had the highest days in accounts receivable (DAR) — an average of 44 days as compared to 26 days for all payers — and had the highest denial rate and lowest electronic remittance advice (ERA) transparency,” according to EHRIntelligence.com. These public payers were around three times as likely to issue denials compared to all payers, confirms reported data.
Payers focused on health outcomes
As the transition to value-based payments evolves, this perhaps implies healthcare insurers are focusing much more heavily on the patient population space. As mentioned previously, this is an area that demands more attention. It is possible this also means an overall reduction in healthcare waste in connection with the Affordable Care Act (ACA), according to Fortune, which denotes the healthcare industry's spending has declined.
Says Fortune, "Employers and consumers, aided by the ACA’s incentives, are pushing the market to emphasize value and outcomes, compared with the outdated focus on volume. As a result, insurers are focused on health outcomes for patient populations, providers are changing how they care for patients and pharmaceutical and medical device companies are changing their investment and product development strategies. All the while, healthcare consumers are benefitting."
As the role of healthcare payers evolves, it is hopeful gaps will be addressed to stregthen the industry as a whole.
