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Healthcare Reform Technology Tips for Payers, Providers

Scott Kornhauser, for HealthLeaders Media, January 24, 2011
  • Be comprehensive across all lines of business which they can efficiently consolidate and integrate, including the processing of real-time clinical and financial algorithms across multiple lines of business and funding sources.
  • Be web architected for optimal interoperability, flexibility, efficiency through extensive self-service capabilities for all participants.
  • Be flexible enough to enable payers to rapidly innovate, prototype, and ultimately adapt to a wide range of new market business models through configuration by business users verses software development by engineers.
  • Allow payers to efficiently sell, enroll, and support individual business versus group business.
  • Auto-adjudicate not only claims, but complex business processes as well.
  • Support the ability not just to add new functionality, but also to easily locate and apply cost-effective human resources with the knowledge to do the work.

For over 20 years, payers have been locked into systems with fixed sets of capabilities from vendor(s) that have poorly managed their enhancement demand. They have been stuck with very limited abilities to innovate and prototype, a glacial evolution of capabilities, and the need to append all kinds of peripheral systems and custom adaptations to these aging systems. Future-proofingis about handling today’s needs within a technology framework that will efficiently handle the needs of tomorrow. Over the next decade payers will be innovating their way to success through prototyping in a market that will be changing at amplitudes far greater than at any other previous time in our history.

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