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Health Insurance Transformation

In order to maintain its own fiscal health, the health insurance industry must build the technology and processes needed to meet consumerism's demands.

Health Insurance Revival Requires Process and Technology TransformationExecutive Intelligence Series

As a transaction-intensive industry, health insurance has benefitted, and will continue to benefit, from the efficiencies that technology brings to traditionally paper-driven processes. But the industry is at a crossroads: It not only must improve existing processes, it must also develop new processes and capabilities to meet new customer demands.

Individual consumers are bearing increasing burdens for their healthcare, both in cost and decision-making responsibility. Whether conceived as incentives to choose lower-cost healthcare options or as offerings to support an individual's decision-making, so-called "consumer-directed" health plans and their accompanying tools mark a revolution from product- and plan sponsor-oriented processes to a consumer-oriented paradigm.

But it will take more than superficial changes for carriers to succeed in the new, customer-centric health insurance world. And internal changes alone will not suffice. Inefficiencies plague health insurance, owing largely to the absence of standardized processes across the industry. As WellPoint's Ron Ponder comments (page 28), the health insurance industry needs to follow the example of the banking industry to make the transition from one insurance carrier to another as easy for a doctor as going from one ATM to another is for a banking customer. To achieve this, industry leaders need to establish standards and invest in initiatives to help their healthcare provider partners transition to the next generation of healthcare technology.

The industry may be helped by the President's appointment of David Brailer as the first National Health Information Technology Coordinator, as well as by the Administration's mandate to institute electronic medical records within a decade.

But, whatever happens among companies, within companies a new ethos must prevail, according to Michael Battaglia, Humana's chief consumer officer and head of the carrier's Integrated Consumer Experience (ICE) group. The consumer-directed health trend will fail if it isn't about more than simply saving employers money, Battaglia asserts (page 36).

With the growing popularity of flexible spending accounts, health plan members' personal finances come more directly into play with their healthcare decisions than ever before. Card-based payment technologies are one way carriers can drive speed and efficiency of transaction processing (page 38). And, just as technology plays a leading role on the frontier of health insurance, it can also help carriers deal more successfully with the traditional problem of fraud (page 40).

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio

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