News & Commentary

11:28 AM
Michiel Walsteijn, Oracle Health Insurance Solutions
Michiel Walsteijn, Oracle Health Insurance Solutions

6 IT Competencies That Health Insurers Must Master Post-Reform

One of payers' biggest challenges is in the way that they go to market as the Affordable Care Act completes rollout. Insurers must implement flexible IT systems that enable unprecedented business agility.

Ready or not, healthcare reform is underway in the United States. The pace is accelerating, and by most accounts, effects will be far-reaching. Established insurers are looking to acquire new capabilities; new competitors are entering the market; and everyone is working to position themselves to comply efficiently, surmount challenges, and, most important, capitalize on new opportunities.

The individual mandate, a critical component of the Affordable Care Act upheld by the U.S. Supreme Court in June 2012, creates an opportunity for disruptive innovation in all areas of the healthcare payer's business. The individual market holds great potential for payers to provide new product and service offerings that retain profitability and growth. As with every opportunity, however, there is associated risk. While states debate whether to expand Medicaid, launch health insurance exchanges, or both, payers have less than 18 months to plan their strategies, change their infrastructure, and launch new products to capture market share.

One of payers' biggest challenges will be in the way that they go to market – maintaining a business-to-business strategy while also learning how to increasingly market to and transact with business-to-consumer. Long accustomed to b-to-b transactions, payers must now learn to interface directly with end users as well as understand the nuances of local markets. Payers must implement flexible IT systems that enable unprecedented business agility. These systems will be critical to their success.

Today, as payers expand b-to-c capabilities, they must keep in mind that the b-to-c model requires some fundamental shifts in the way they do business — ultimately affecting their entire enterprise platform: claims processing, provider contracts, benefit design, billing, marketing, communications and IT infrastructure. To more easily cope with these kinds of changes, payers should ask themselves questions including, but not limited to, the following:

  • How will we market to individuals?

  • How can we use health insurance exchanges as a new sales channel?

  • How will we make our offerings appeal directly to consumers in the speed to market and cost-containment pressures of the retail world?

  • What new programs can we put in place for consumers to manage their own healthcare choices?

[Read how some health insurers are taking lessons from successful online retailers]

Taking the time to address these questions thoroughly and sooner versus later will help payers determine their technology and other organizational requirements and, ultimately, build a solid foundation for success. Ensuring enterprise-agility remains a challenge, but to meet it head on, payers need to take a hard look at their underlying IT infrastructure to determine if it is flexible enough to accommodate individual consumers and roll out new products quickly; if systems are configurable and do not require custom coding when business needs change; and more.

1 of 2
Comment  | 
Print  | 
More Insights
Newest First  |  Oldest First  |  Threaded View
Register for Dark Reading Newsletters
White Papers
Cartoon Contest
Write a Caption, Win a Starbucks Card! Click Here
Latest Comment: This is a secure windows pc.
Current Issue
Security Operations and IT Operations: Finding the Path to Collaboration
A wide gulf has emerged between SOC and NOC teams that's keeping both of them from assuring the confidentiality, integrity, and availability of IT systems. Here's how experts think it should be bridged.
Flash Poll
New Best Practices for Secure App Development
New Best Practices for Secure App Development
The transition from DevOps to SecDevOps is combining with the move toward cloud computing to create new challenges - and new opportunities - for the information security team. Download this report, to learn about the new best practices for secure application development.
Twitter Feed
Dark Reading - Bug Report
Bug Report
Enterprise Vulnerabilities
From DHS/US-CERT's National Vulnerability Database
Published: 2017-05-09
NScript in mpengine in Microsoft Malware Protection Engine with Engine Version before 1.1.13704.0, as used in Windows Defender and other products, allows remote attackers to execute arbitrary code or cause a denial of service (type confusion and application crash) via crafted JavaScript code within ...

Published: 2017-05-08
unixsocket.c in lxterminal through 0.3.0 insecurely uses /tmp for a socket file, allowing a local user to cause a denial of service (preventing terminal launch), or possibly have other impact (bypassing terminal access control).

Published: 2017-05-08
A privilege escalation vulnerability in Brocade Fibre Channel SAN products running Brocade Fabric OS (FOS) releases earlier than v7.4.1d and v8.0.1b could allow an authenticated attacker to elevate the privileges of user accounts accessing the system via command line interface. With affected version...

Published: 2017-05-08
Improper checks for unusual or exceptional conditions in Brocade NetIron 05.8.00 and later releases up to and including 06.1.00, when the Management Module is continuously scanned on port 22, may allow attackers to cause a denial of service (crash and reload) of the management module.

Published: 2017-05-08
Nextcloud Server before 11.0.3 is vulnerable to an inadequate escaping leading to a XSS vulnerability in the search module. To be exploitable a user has to write or paste malicious content into the search dialogue.

Dark Reading Radio
Archived Dark Reading Radio
In past years, security researchers have discovered ways to hack cars, medical devices, automated teller machines, and many other targets. Dark Reading Executive Editor Kelly Jackson Higgins hosts researcher Samy Kamkar and Levi Gundert, vice president of threat intelligence at Recorded Future, to discuss some of 2016's most unusual and creative hacks by white hats, and what these new vulnerabilities might mean for the coming year.