The Digital Insurer: Challenges & Opportunities

By Devin A. Jopp, Chief Information Officer, Health Insurance Association of America

In an increasingly difficult economic environment, with health insurers being squeezed between the rising administrative costs of complying with new HIPAA standards and the continual rise of medical costs, insurers are looking for innovative methods to not only reduce their costs, but also to increase efficiency and improve customer service. The usage of Web technology to reduce administrative costs and increase customer self-service is a trend that has been steadily gaining traction over the last several years.

Historically, most applications of Web portal technologies have been applied to providing consumer access portals. These portals typically allow health plan members the ability to view claims data, review benefit coverage, and browse in-network doctors and hospitals and the drug formulary listing. Some even offer wellness information via member portals. The true value of consumer portals lies not only in allowing the consumer to perform self-service, but also in reducing the health insurers' costs associated with maintaining large call center volumes.

Although portals for business-to-business applications receive slightly less attention, they offer perhaps a greater opportunity for reducing costs. Three distinct types of business-to-business portal solutions have emerged: employer, producer and provider portals.

Employer portals are business-to-business solutions that allow employers the ability to administer their health plans by allowing them to view benefit information and enroll or dis-enroll employees. For producers, these portals typically refer to sales force automation tools, where a single sign-on point is developed for producers to submit new policies and review the status of pending policies. The benefit for health insurers lies both in providing better service to employers and producers, and in reducing the costs associated with staffing call centers to assist with benefit changes or check policy status.

Provider portals also offer health insurers a significant opportunity to reduce costs by streamlining communication with physicians. Typically, these portals allow physicians to not only submit and review claim information, but also allow physicians to check patient eligibility and clinical guidelines. Some HMOs are also extending the capabilities of these portals by integrating electronic medical records (EMRs).

The future of Web portals for business-to-business and business to consumer applications is bright. However, the challenge remains that in order to effectively implement these types of portal solutions, health insurers must leverage their legacy systems. Many insurers are faced with 20-year-old+ systems that will most likely be around for many years to come. The obstacle for insurers is to effectively integrate these legacy systems with the newer Web technologies.

How are the industry's leading companies dealing with this challenge? The Health Insurance Association of America's Annual Forum, October 2-4 in New Orleans, will feature a panel discussion by Bruce Goodman, Chief Information Officer for Humana, Jim Hanson, Executive Vice President for Mutual of Omaha; and Wei-Tih Cheng, Senior Vice President and CIO for Aetna (invited) that will further examine the role that Web technologies will play in the shaping of the digital health insurer. For more information and to register, visit www.hiaa.org .