The healthcare industry is in a constant state of flux, and organizations still struggle to keep up ever-evolving demands. In the past, the most prevalent diseases in the world were communicable illnesses such as influenza, pertussis, and tuberculosis. Nowadays, lifestyle-driven chronic conditions like diabetes, heart disease, and obesity pose more of a threat to the global population. For this reason, the delivery of care has had to shift from treatment-based interventions to prevention-focused methodologies. Meanwhile, healthcare costs continue to be on the rise throughout all of this. Of course, this has led to a number of trends across the healthcare industry.
Health insurance providers who wish to survive in this demanding environment need to be able to respond to these changes as they happen to better serve their customers. Unfortunately, the industry tends to cling to systems that are woefully out of date for various reasons that, while perfectly valid, also hold them back. This can create numerous gaps that can lead to inefficiencies, causing companies to lag behind in areas that are crucial to onboarding new customers and retaining existing ones. To accommodate these changing needs, there are several revolutionary healthcare technology developments to follow.
Fortunately, digitalization and advanced health insurance technology can address many of the challenges that health insurers face. Here’s how:
It Enhances Claims Processing And Management
Claims processing and management have long been considered major pain points in the healthcare lifecycle. So much so, in fact, that on the 2019 American Customer Satisfaction Index, health insurance companies ranked dangerously close to the bottom along with airlines, just below companies that provided mobile phone services.
This kind of discontent is caused by numerous factors, but claims is undeniably one of the areas that is of significant concern to many customers. Specifically, respondents felt that their health insurers were less than timely when it came to claims payments. Because consumers and plan sponsors are paying more for premiums and out-of-pocket costs than ever before, it’s easy to see the reason behind their dissatisfaction. Clients simply don’t feel as though they’re getting what they’re paying for.
Unfortunately, improving the claims experience for the customer is no easy task. The main obstacle for health insurance companies is cost. Indeed, claims processing is expensive for both health insurers and participating providers. In the United States, the medical industry spends USD 4.5 billion on claim submissions every year. This figure represents 13 percent of the total medical industry expenditures on administrative transactions. Claims status inquiries are similarly costly, as they are the second most expensive transaction to conduct in the medical industry, both manually and electronically.
Investing in modern technology can help health insurance companies overcome these issues. Switching to fully electronic transactions can significantly lower administrative transaction costs by up to USD 454 million annually. Similarly, shifting manual and partially electronic web portal claim status inquiries to fully electronic operations can help firms save up to USD 2.2 billion per year. Automating claims processing and adjudication also creates a better experience for customers, speeding up turnaround times for these tasks and allowing them to receive their claims payments more quickly.
It Allows Health Insurers To Experience The Benefits Of Cloud Computing
By now, the benefits of cloud computing are proof enough that most industries have begun to make use of cloud services to perform some of their most essential day-to-day tasks.
For the health insurance industry, in particular, pivoting to cloud services is a cost-effective, flexible, scalable, and secure way to modernize clunky and outdated legacy systems. All of the processes in the entire claims and policy administration lifecycle, including analytics, authorizations, claims adjudication, claims pricing, commissions, and value-based payments can be accessed and managed from a single pre-configured platform that needs little intervention but remains fully customizable. Cloud computing services also reduce IT and maintenance costs because the solution is located off-site.
It Helps Health Insurance Firms Improve Member Engagement
Finally, modern technology can help bridge the gap between health insurers and consumers by creating more opportunities for engagement. Through next-generation machine learning and artificial intelligence, not to mention big data and analytics, there are more ways than ever to learn everything about a customer. This information can then be used to provide a highly personalized health insurance experience for that customer on the same day they sign up to become a member.
Modern technology also empowers health insurance firms to switch from a reactive approach to a more proactive one. Instead of waiting for members or caregivers to seek health services, the company can use the data they’ve gathered via user input, Internet of Things-connected devices, and wearables on the customer to predict possible medical issues and proactively reach out to them to propose the most appropriate interventions.
Indeed, modern technology is the solution to a lot of the issues plaguing the health insurance industry today. By employing it meaningfully, health insurance companies will be able to reduce operational costs, minimize reliance on antiquated systems, and attend to their members’ needs more efficiently.