Q: What technology issues do insurers need to address to effectively implement the use of cards for health insurance payments?
A: Richards, Cigna: From an insurer's perspective, it's critically important to work with a partner that has a lot of experience in debit card transactions, especially when it comes to security and fraud, as well as authentication issues. Cards represent a different business than health insurance, and working with an experienced partner is crucial.
A: Sacco, MyHealthBank: To be effective, there must be online connectivity and real-time access to information regarding eligibility and allowable amounts for specific types of providers, care plans, therapies and procedures. Without this access, post-event adjudication and claims processing can be overwhelmed by recoding and denial activity, thus significantly impacting administrative costs, provider network relations, member satisfaction and future marketability of similar plan designs.
A: Roma, DiamondCluster: Smart cards extend the health insurance enterprise to the point of delivery by providing confidential health information on a portable platform. Integrating the various touchpoints (e.g., medical, dental, pharmacy) to service cardholders will require health insurers to make significant investments in their core legacy systems. With the increasing emphasis on privacy, encryption and digital signatures, it will be necessary to secure information. Concerns with privacy and the lack of understanding of these technologies by both patients and doctors will continue to be barriers to mass adoption.
Q: What are some of the challenges or risks insurers face in implementing cards?
A: Richards, Cigna: One of the considerations that really needs to be thought through is how the plan integrates with the health plan. In order to really maximize the convenience for the customer, these cards can't be a separate mechanism outside the infrastructure of the health plan. Integration is critical.
A: Sacco, MyHealthBank: One of the biggest challenges is creating processes and systems to facilitate these new types of POS transactions that are embraced by providers and patients as a better way of doing business - less complicated, more efficient, improved satisfaction. Inevitably, something new brings with it high expectations from end-users. Ensuring that the appropriate connectivity and technology infrastructure are in place to maintain timely and accurate eligibility and administrative data is critical. Without this access to data, reconciliation has the strong potential of being far messier than straight billing processes and can result in a black eye for these new plan designs that slows present and future adoption.
A: Roma, DiamondCluster: There's a major challenge in shifting from long processing cycles to one that's nearly real time. Consumers will expect the same access and customer service for their consumer directed health plan accounts as they currently get with their bank and equity accounts. Initially, data stored on smart cards will be replicated, but synchronization challenges will lead to an architecture that essentially allows the card to access a central Book of Record. Another challenge will be establishing communication standards to link back to the enterprise to refresh information on cards and to provide a means for consumers to display or print data.
Q: Are there other emerging payment technologies that carriers should be watching in the healthcare/insurance space?
A: Richards, Cigna: Certainly, Cigna is watching smart cards, non-U.S. initiatives and biometrics. Smart cards have been particularly adopted over in France, including even things like Level III information in debit cards. The tipping point on this in the U.S. will be adoption by the medical provider community, including pharmacies and other retailers that sell prescription and over-the-counter drugs. It's fine for Cigna to come up with a smart card strategy, but until the physicians and hospitals and pharmacies we work with adopt a smart card, it doesn't do our consumers any good.
A: Sacco, MyHealthBank: While still embryonic, an emerging trend impacting payer-provider relationships involves implementing full payment at the time of service. Insurers will identify certain providers and specific procedures (e.g., preferred physicians and high-volume, low-cost services). Reimbursement will be made at the point of service using a combination of Internet and card capabilities. Funds will be dispersed from the insurer, cash accounts (flexible spending, health reimbursement and health savings accounts) and from the patient's own funds when authorized. The maze of paperwork thus will be reduced, increasing both consumer and provider satisfaction.
A: Roma, DiamondCluster: Smart cards, fingerprint devices and retinal scans will help reduce paperwork and secure access to patient information. These solutions provide the ability to authenticate members with biometrics and other data stored on cards and will provide efficient processes to verify eligibility and track accumulators. Smart cards will link transactions in real time to health insurers' back-end systems to perform real-time fraud detection and other services to drive out existing inefficiencies in the value chain. The conversion to electronic medical records (EMRs) will be a critical step. With fewer than 20 percent of primary-care physicians using EMRs, significant investment is still required by health insurers, doctors and hospitals before smart cards will reach the mass market.
Peggy Bresnick Kendler has been a writer for 30 years. She has worked as an editor, publicist and school district technology coordinator. During the past decade, Bresnick Kendler has worked for UBM TechWeb on special financialservices technology-centered ... View Full Bio