One of the biggest problems the healthcare industry must overcome is learning to communicate in a digital world. Our systems all speak in different languages, sometimes even behind the walls of the health plan, not to mention between providers and the health plan. At the end of the day, the member is left to figure out what it means.
Recent regulatory rulemaking is pushing the industry into the digital world, and there is no going back. Yet, the industry still struggles with the paradox of protecting members’ data behind firewalls and policies necessary under HIPAA and other rules and releasing it out to applications unknown. There are endless pockets of information, with no reasonable way for everyone to access the correct message at the same time.
Respondents in a recent survey of 220+ health plan executives cited lack of access to real-time data and information sharing as having the biggest negative impact on provider relationships. The frustration comes when it takes so long for providers to get the information they need to care for their patients.
In an ideal situation, a provider would have real-time communication with the plan and know exactly what services are covered for a member and what requirements might be in place for preauthorization. With real-time information, a provider can resolve an issue on first contact—a member can go into their provider’s office and not have to wait three days or even five days to find out whether or not they can schedule an elective procedure.
Reaching this ideal state is not impossible. The technology that enables real-time information sharing has been around for a long time. Look at banking, for example—we have all seen the benefits of its evolution from paper to digital. People can transfer money in seconds on their phones. Ten years ago, someone would have to go into the bank, fill out paperwork, transfer the money, then wait (sometimes hours or days) for confirmation that the money was received. These steps are not necessary today. I cannot tell you the last time I went to an ATM, spoke with a teller, or even called the bank; even then, I probably used an automated system.
While healthcare is different than finance―we certainly don’t want to lose the personal touch―both industries are highly regulated with massive amounts of data that needs to be available and secure. By looking at the financial industry’s transformation, healthcare can solve many of the causes of frustration between the members, plans, and providers and evolve the relationship beyond just verifying information.
HealthEdge is looking at ways to create synergies between the traditional processes of the industry, the rapidly changing regulatory requirements, and the laws behind these rules to develop solutions that enable compliance and provide benefits to our customers and ultimately improve the overall health of the members.
Striking a balance between standards, process, and technology will enable all of the players to communicate digitally in a manner that benefits everyone.