Healthcare Reform Technology Tips for Payers, Providers

The entire U.S. healthcare system is focused on building a new technology foundation upon which a new performance based delivery system can be architected over the next decade. There are a number of critical success factors including an efficient administration of healthcare benefits and adaptation of a wide range of new market business models.

While no one can predict the specific technology feature/function set that will be required by healthcare payers in 2015, there are some technology mandates of the future market that are predictable given what we know today.

These mandates include, first and foremost, the realtime integrated processing of all healthcare business transactions, similar to the point-of-sale (POS) processing enjoyed in the pharmacy line of business for more than 25 years. The healthcare market is aimed at lowering costs through improved care and outcomes. To accomplish this, an electronic, interoperable, integrated delivery system is necessary in order to achieve optimal performance. 

From the federal government to the commercial payers and providers, the whole market is focused on building a new technology foundation upon which a new performance based delivery system can be architected over the next decade. Real time information exchange and processing will be at the core of this new delivery system.

Today, a number of factors are driving many payer organizations to finally address the long delayed decision to update their core administration systems:

• National healthcare reform calling for tens of millions of new individual members to insure
• Increasing market focus on performance-based delivery of care
• The promise of continued and accelerated change amid the increasing politicization of healthcare
• New industry standard requirements (e.g., HIPAA 5010 and ICD-10)
• Increasing competition in key markets