Transparent Motives
Payers and Healthcare Transparency
In a survey of U.S. payer organizations, research firm Health Industry Insights found that more than half of respondents plan to make significant investments in transparency initiatives in 2008. According to Health Industry Insights, key payor initiatives include investments in creating electronic access to information; improving data and information processes; consolidating duplicative, redundant, or disconnected data sets to produce accurate, reliable data sources; adopting standards; and moving toward common formats.
For key survey findings on online claim payment and adjudication, cost and quality information and payor investment trends in 2008, please click on the "Continue Reading" link below.
Online Claim Payment and Adjudication
Online and real time claim adjudication and payment is the cornerstone of transparency initiatives – providing real-time and personalized cost and payment information to both consumers and providers. Among the healthcare payers surveyed, only one third (35%) indicated current initiatives to execute on-line real time claims adjudication across their enterprise. Of those with planned real time adjudication initiatives, just 19% reported executing strategies in 2007. An additional 18% indicated plans to execute real time adjudication by the end of 2009
Cost and Quality Information
Despite challenges in providing reliable and comparable cost, quality, and outcomes information, nearly two thirds (64%) of healthcare payers surveyed reported at least some cost and quality transparency initiatives in 2007. In a separate survey, all healthcare payers reported accuracy and reliability challenges with the cost and quality data they presented. Most attributed the challenges to lack of strong processing environments, consistent formats and lack of timely (or real-time) information.
Transparency Investments 2008
Among the insights into future technology transparency investments, more than half (53%) of healthcare payers surveyed planned no additional investment in 2008. Despite the consumer and employer demands, challenges with data availability and accuracy and questions about usability, privacy and security will limit transparency investments in 2008. Instead, healthcare payers will assess the effectiveness and return on early initiatives to identify best practice industry models.
Payor PR pros may be interested in checking out Health Industry Insights research, searchable on parent company IDC’s Web site. Other reports include Challenges of Transparency (Doc #HI207608), The Transaction Side of Healthcare Payer Financial Transparency: What's Real About Real-Time Claim Processing and Payment in 2007? (Doc #HI208537), Healthcare Payer Transparency Initiatives: Managing Provider Data (Doc #HI208117), and Next Generation Transparency Attributes: Personalized and Integrated – A Model and Example.
Posted by Shawn Whalen on March 3, 2008 at 12:16 PM
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