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Markets & Clients | Health Insurers
Health Insurers
The debate about how to “fix” the healthcare system continues to intensify at the highest levels. The United States continues to spend billions of dollars on healthcare and the costs continue to rise. As employers shoulder this growing burden, they continue to search for answers. The complexity surrounding the issues means that there is no easy solution or quick fix. One thing is clear – long-range strategic thinking that drives operational excellence will play a critical role in the eventual transformation of the industry.
Health insurers want to support procedures that have clinical efficacy based upon concrete evidence. According to a recent Rand Corporation study, when you go to the doctor, you get evidence-based medicine about 55% of the time. This means that a patient is not getting generally accepted best practice care 45% of the time. The notion of a “standard of care” is artificial – the result is increased cost and decreased patient care and safety. Capturing the best practices, adopting outcome-based management principles, and applying the right technology will enable you to build better bridges to successful patient care.
In addition to enhancing patient care, administrative activities such as claims processing, eligibility verification, and new patient enrollment are becoming increasingly efficient through streamlined business processes and targeted technology. The result is lower costs and greater customer satisfaction.
Some technology vendors claim to be the be-all-end-all answer to health insurance ills. Sometimes they are far from it. A perfect example is the recent adoption of electronic health records. While the IT department may love it, physicians are not totally convinced. Bridging the gaps between people, process and technology remains paramount in the success of any major strategic initiative.
Long-range strategic thinking coupled with the results-oriented implementation of business processes and the right technologies will help your organization become more efficient and effective.
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