Outdated Technology Burdens Health Insurers: Study

An increasing number of healthcare payors say that to reach new markets, they need better technology.

More healthcare payors are interested in updating their technology but also say that their current system would not support a new design, says a survey by HealthEdge, a technology provider for healthcare payors.

About 78% of payors are looking to expand participation in Medicare and Medicaid, while 71% are exploring Pay-4-Performance initiatives. Also, 61% want to participate in the Accountable Care Organization (ACO) model.

However, about 47 percent indicate that they do not have the technology to support this, while 60.5% of respondents say they do not have the technology to support the next-generation Consumer Directed Healthcare Plans.

About 52% have the same issue in supporting Value-Based Benefit Designs, a model that focuses the consumer’s out of pocket expense on the value of service, not health. However, 41% say they are planning to support the VBBS design in the nest 3 year, while 61% plan to support the ACO model.

“Unfortunately, as the survey results show, much work still needs to be done to ensure that payors are technologically ready to support these important new initiatives,” says Ray Desrochers, EVP of Sales and Marketing at HealthEdge, in a release. “Payors need to leverage modern technology platforms to transform their businesses and complete in the new healthcare marketplace.”

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Insurers are also relying on costly processes to handle transactions. About 55% say they automate the adjudication process for less then 80% of claims. Sixty percent say they pay $6 or more to manually adjudicate a claim.

About 100 insurers responded to the “State of the Payor” survey, which is conducted three time a year.

Zarna Patel is a staff writer for InformationWeek's Financial Services brands, which include Bank Systems & Technology, Insurance & Technology and Wall Street & Technology. She received her B.A. in English and journalism from Rutgers University College of Arts and Sciences in ... View Full Bio