While visiting the White House Health Reform website this week, I thought about a statement in a feature piece that stated:
“After nearly a century of trying, and after more than a year of extensive debate, the President signed into law a health reform bill that brings down health care costs for American families and small businesses, expands coverage to millions of Americans and ends the worst practices of insurance companies.”
“Worst practices” jumped out at me. While worst practices of healthcare insurance companies and other payers has been the focus of much of the debate over the past year, I like to look at what insurance companies need to do to focus on best practices: on reducing their costs while providing better information to hospitals and patients to improve care.
For 10-15 years, most payers have been in a state of turmoil as they deal with multiple compliance measures and increasing amounts of data to maintain, control and exchange. These changes have included electronic data interchange (EDI) regulatory mandates such as HIPAA EDI 5010, NCPDP, ICD-9 to ICD-10 conversion, meaningful use, HITECH (PHI), etc. Each of these mandates will require massive effort so that payers can meet all requirements (which by the way will come in rapid fire order over the new few years). Insurance companies and payers have started to really feel the pain that can accompany change.
Add to that the ‘burden’ of the new health reform laws, which call for an expansion of EDI standards along with uniformity of EDI usage between entities and some insurance companies can quickly go from turmoil to overwhelmed.
I maintain that it’s time to start managing the chaos. If insurance companies and payers have not begun to find technology solutions that help collect, control and manage data, they will soon be hit with penalties. The time to evaluate one’s organization’s data and practices is now.
The good news is that the additional burden is based on the CAQH organizations recommendations which press for uniformity, much like their CORE certification. Organizations can evaluate their systems now, because the test data and certification requirements are all openly published, without having to pay for certification. We at BridgeGate used their test data (Phase I and Phase II) and found that compliance is not tough at all.
The only way to solve this is massive data onslaught is to relook one’s approach. This is a business issue, not an IT issue. What will win the day for the payers is not how much money or programmers can be thrown at the problem, but how successful a flexible and business-oriented approach can be. One path to get there? Use an integration platform where the business can configure and control at the hub, and let IT program at the periphery where needed. The business side has to be actively involved in the change, or all of this burden on top of turmoil will bury the IT groups within insurance companies worse than Y2K.
Change is here, and integration helps manage change.
