- New technologies and health IT tools are becoming a necessary part of the health insurance industry, as innovative approaches like automation can largely benefit employees while portals could make a difference for health plan consumers.
When speaking with Kimberly Branson, the Vice President of Business Architecture & Strategy at health insurance company Medica, the health insurance expert mentioned how vital health information technology is for payers around the nation.
“Information technology is an imperative for payers,” Branson began. “From a core administration perspective, the core responsibility of a health plan or a payer is to finance healthcare.”
“The way that it’s done is pretty complex between the payer and the provider. Having information technology that helps to automate workflow and automate the transfer of information within and in-and-out of a health plan is critically important,” she continued. “In an age where the industry is becoming even more and more focused on government oversight and compliance, improving automation improves quality, which improves your plan’s capability on ensuring compliance as well.”
“Technology, from my perspective, is as important as the people and is as important as the process.”
Dennis Carlson, President of insurance consulting agency Bespoke Benefits, and Limelight Health CEO Jason Andrew spoke with HealthPayerIntelligence.com to offer more information about how automation and health IT impacts the payer industry.
HealthPayerIntelligence.com: What are the biggest advantages of automation in the health payer industry? Are there any disadvantages?
Dennis Carlson: “I don’t see any disadvantages to further automating health IT on the payer side and there’s actually more and more need for it. It’s going to be a while before we need to back off on automation.”
“Advantages from a policyholder standpoint, the ability to submit claims via a web portal or even by phone has tremendous value in the ability to get those claims in and reviewed quickly. Also, it allows employees to get responses from claims faster. An employee who files a claim online can go and view that claim to find out what was paid and what wasn’t.”
“When there are issues with claims, it makes it much easier to engage other parties like brokers. Once we’ve had a HIPAA release authorized, we can go in and review those claims to find problems. We can follow up directly with the payer to find out why some claims weren’t paid properly.”
“That’s one piece of automation that exists right now on the payer side that allows things to move much more quickly rather than filling out forms and mailing them.”
Jason Andrew: “I think probably the greatest advantages of automating is being able to pick up efficiencies, help drive down cost, and providing a better experience across the system for providers, payers, business owners, consumers, and folks who are selling and servicing health insurance. Across all those different channels, it’s extremely fragmented right now.”
“Depending on where you’re purchasing insurance, where you’re accessing your care, what size of a company you are, or whether you’re an individual – it’s very fragmented. The more that we have connected systems, it would help with workflow automation, better analytics, and better tools. It provides a much better experience, cut down on a lot of errors, and reduce costs long-term.”
HealthPayerIntelligence.com: How has automation and health IT helped payers meet mandates of the Affordable Care Act? Has it cut administrative costs?
Dennis Carlson: “I can’t speak from the payer’s perspective on whether it has cut costs, but I can tell you from the broker and employer perspective. When you look at the Affordable Care Act and the way that it changed a lot of things and not just the policies – certainly the policies with metal tier programs are more uniform than they were before – but also within those metal tiers, you have a lot of differences in policies.”
“As an example, a gold level health plan from Kaiser can be very different from a gold level health plan from Blue Cross of California and very different from one from Health Net. They all may have similar copays and deductibles but the nuances can be very different.”
“The way that relates to IT is that we have systems now which allow for the tracking of all these different types of policy nuances where the policy information can be loaded onto an online system and a broker like us can review those policies quickly.”
“We can now sort and filter by deductibles, by copays, and by coinsurance very quickly and narrow down the options for our client and show them a sampling of options rather than showing them 300 different health plans.”
“Further into that is the rating methodology. The rating methodology completely changed under the Affordable Care Act. Before we had age-band rates for small group health insurance and now, for small group health insurance, the rating methodology is completely different. Now we’ve gone to number-level rating, which means that every single member is rated at their particular age.”
“Technology has come in and automated all this for us as brokers. We use online quoting solutions to allow us to sort and filter options to display them to employers. We can also automate that process to show employees which options they’d like to enroll in and then give them the opportunity to enroll right online.”
“You can see across the chain from quoting the plans and giving information all the way to the employee making decisions for which plan to enroll in. All of that has been automated through online software.”
Jason Andrew: “I don’t know that we’re seeing any of those cost efficiencies showing up yet. I think it’s still pretty early on. I think a lot of the providers and payers have been historically pretty slow to adopt new technology and a lot of them have older legacy systems, but I do think because of the advances that we’ve seen in cloud-based infrastructure and the ability to scale businesses quicker, we’re seeing broader adoption.”
“More importantly, because of the downward pressure on the Affordable Care Act, to be able to get the medical observations under control, I think we’re seeing a greater adoption of technology we’ve seen in the last 12 months. Most carriers are starting to invest in new technologies or hiring a lot more.”
“I spoke with senior executives at different health plans and they were all looking at hiring or already had hired data scientists and developers. There may be some reports out there showing that we’ve already seen some of that, but I actually think it’s a work in progress and we’re actually starting to figure out where we’re going to pick up some of those efficiencies.”
HealthPayerIntelligence.com: What are some challenges and complications you’ve encountered when adopting automation technologies at your organization?
Dennis Carlson: “The biggest obstacle we encounter when trying to implement a new technology is figuring out whether it’s compatible with our other technologies. Interoperability and integration can be a big challenge.”
“Fortunately, there are technologies now that are more compatible and have an open API that allow us to connect the different solutions that we use, but that’s probably the number one challenge that we face when we look at a technology.”
“Sometimes the technology can look great as a standalone automation tool but if it doesn’t integrate with the other tools that we’re using, it’s problematic. There is no single one solution that does absolutely everything you need to do end-to-end that exists today.”
“The biggest challenge is finding other tools that will interoperate with the tools that we use.”
Jason Andrew: “For us, as a technology company, that’s working to help automate some of the different aspects of the manual work being done now. Some of the challenges are being able to actually connect to some of the other tools.”
“You’ve got APIs which are very standard in a lot of technology companies these days but not so standard in the industry. Access to that data is a challenge. There are a bunch of different companies committed to doing things around payments and enrollments, but to get the standardized data set in APIs or connectivity with each of the providers and payers – who all have different systems – is a real big challenge and I think we’re still pretty early in the market.”
“Even a lot of the systems that power folks that support the industry – whether it’s doctor offices, brokers, agents, and underwriters that work with health plans – don’t communicate or there’s not one repository for all of this.”
“As that infrastructure is being built out and we connect to more of it, I think that we’re seeing some really great success there, but it’s a long road to really penetrate and get in. I think having more and more standard sets of data and connectivity are starting to help that.”
HealthPayerIntelligence.com: How does automation and health IT impact health plan consumers? Does it improve satisfaction?
Dennis Carlson: “I would say it improves satisfaction because I firmly believe when we’re talking about employee benefits in general and more specifically health insurance, the value the employee receives from an employer’s health insurance program is 50 percent the actual product and 50 percent the perceived value of that product.”
“What I mean by that is whether the copays are reasonable, whether the deductible is reasonable, are the prescription drug copays reasonable, and does it have a good provider network?”
“Actually, understanding how to use that policy is part of that perceived value. What technology does is allow employees to more quickly understand how their plans work and allows them to better use them. Whether you’re talking about claims support or simply how much they’ve met of their deductible that year or even what a deductible is and how it works, automating all this and consolidating instead of getting a stack of papers is beneficial and improves satisfaction.”
“Consolidating allows them to quickly make decisions about which plan is right for them and their families. This raises the perceived value of that plan for that employee.”
Jason Andrew: “Without a doubt. As someone who’s been in a role on multiple sides in terms of working with user systems, working with exchanges, working with health plans, working with employers, and being a consumer myself, when I come across a technology that works seamlessly and provides me with better data in terms of the decisions that I’m making, it’s an extremely better experience.”
“Part of what we’re working at building in my mind has been aimed at a lot of the frustration I’ve had as a consumer and as a business owner in terms of the systems that are available to use and navigate. As we improve on that, that experience makes a significant difference.”