A look at the drivers, restraints, challenges and opportunities for healthcare payer technology in 2019. It’s 2019: do you know what’s going to happen in healthcare payer technology this year? We’re taking a thoughtful look into a few healthcare trends to evaluate challenges and how health plans can turn them into opportunities in the coming year. And no, you won’t need a crystal ball — just a little assistance from advanced technology. To get a good idea of the future, we have to look at the past and present state of the healthcare payer market. It’s understood that in 2019 value-based care will continue to be the dominant theme in healthcare, becoming a strong political platform both domestically and globally. As health plans enter into a newer, more symbiotic relationship with providers (who increasingly take on payer-like roles), the market grows increasingly complex.
What Will Drive Health Payers in 2019 Health plans are being asked to do more with less, so it makes sense that we will continue to see healthcare payers outsourcing supportive services this year. In doing so, they free up valuable employees to do other higher-value activities (read more about how outsourcing can positively impact health plans). Additionally, a shortage of skilled healthcare IT professionals is bringing to light additional business partner opportunities for health plans. The effects of the Affordable Care Act are still being felt in the rise of Americans now insured. And, with a contentious political climate at play, the regulatory healthcare landscape has increased in stringency. CMS continues to issue regulations aimed at improving interoperability and preventing fraud, waste and abuse. 2019 will be the year that health organizations will need to make real upgrades in technology if they haven’t already, or face issues meeting government regulations.  

“The potential for large, self-insured employers and new employer coalitions to cut into the profits of insurers should be a “wake-up call” for organizations.” Fierce Healthcare

  One trend we saw start in 2018 is the increasing consolidation of healthcare organizations (e.g., CVS/Aetna) as well as health system/health plan collaboration. “Large companies like Amazon and Google have one major competitive advantage when it comes to providing insurance options: a deep trove of customer data,” writes Digital Insurance, who also reports that Amazon is rapidly acquiring insurtech startups. Self-insured companies may pose a bigger threat to health plans, especially if they prove more receptive to innovation.

Potential Roadblocks

What wildcard factors will health plans face in 2019?
  • High Incidences of Data Breaches
  • Unexpected Costs Associated With Outsourcing
Particular Challenges At this point, the inefficiencies plaguing the healthcare industry are well known. Administrative complexity has been faulted, yet securely managing data and multiple, competing priorities while adhering to regulations is a complex process. Lack of high-level oversight (transparency) into systems has left health plans siloed, especially when it comes to medical records management. Inefficiencies are delaying processes and increasing provider tension. This leads to more appeals and disputes, and higher costs. We’ve written frequently on the challenges that friction with providers can cause health payers. When patients face challenges like lack of affordability and frustrating interactions with health insurers, providers are a key opportunity to change what may be a negative perception of health plans. But if providers are experiencing similar frustrations like poor communication and lack of transparency, the opportunity is lost. Resolving the friction often found in the provider-payer relationship is a top challenge for health payers in 2019 (and health systems are aiming to repair relationships with providers, too). Opportunities There’s no doubt that in 2019, health payers will continue to prioritize member services and satisfaction. This will be done largely with digital tools that give real-time access to data — such as health records, appointment information, insurance benefit information and more — provided through a portal. In addition, the focus on preventive care (wellness initiatives) should continue to grow in the value-based care market. Technology capabilities will continue to advance this year, as the market has not fully seen the benefits of artificial intelligence. Health payers who adopt innovative technology and change management techniques will gain ground on creating efficiencies and processing big data quickly. The business implications of this move are dramatic, with the potential to improve working relationships between departments, third-party business partners, and network providers. Additionally, the race for 5G is poised to have positive impacts for Americans (both economically and in technology). Advances will be made in electronic health records and services like telehealth will grow. With the right technology and a focus on improving member and provider relations, health payers will be poised to grow in 2019. Partner to Make 2019 the Best Year Yet

Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.

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