Thursday
Feb192009
« Healthcare insurers are changing »
Thursday, February 19, 2009 at 01:12AM
This economic downturn is changing the way healthcare insurers think. They need to change. Competition is heating up among insurance carriers, enrollment is down, and third party administrators are pinching from the other side growing 10% annually. Insurers and TPAs alike are having to fight hard over employers these days.
This tells me that employers should find opportunity in this recession. Rebecca Vesely posts that major insurers are tailoring coverage packages to hold onto commercial members. While insurers analyze their provider fee schedules and premiums for an acceptable margin, they are also offering guaranteed cost savings.
To determine new services in a timely manner, health insurance carriers use technology tools to analyze their historical claims data and integrate that with fee schedules and actuarial data. Those without the right tools will rely on people, like accountants and technology people, to spend many more hours manually collating data into spreadsheets.
Read almost any book on managing companies in a downturn economy and you'll read that for companies to be competitive in hard times, speed, agility, and flexibility are key factors. Cigna is a good example of keeping ahead of healthcare problems. They have concierge services, such as calling households and using their claims data to target members in high risk of serious health conditions. Cigna is targeting a 2.8% reduction in medical costs for employers.
Creating these new services in a timely manner is done having the 'right' tools in place and knowing what employers want. This is more than spreadsheets populated from IT. Integrating information from various sources, like claims systems and fee schedules, is challenging. Quality of the data and knowing how to cleanse the information to make it meaningful is sometimes an art, more than a science.
Many insurers and TPAs have resources stretched thin. Asking them to work more hours and get into the guts of the data can be too much. (Not to mention employers are planning to offer flexible work hours, says Fay Hansen of Crian's Benefits).
More insurers and TPAs these days are focusing on their core business and outsourcing non-core services to companies that spend all their time specializing in web services, reporting, analysis, and document management. And many companies are considering relieving themselves of technology headaches by using internet hosting services, such as SalesForce.com. As David Cordani, COO of Cigna, says, "service is 50 percent of the reason why business goes out the window. We have to make sure our service is strong."
This tells me that employers should find opportunity in this recession. Rebecca Vesely posts that major insurers are tailoring coverage packages to hold onto commercial members. While insurers analyze their provider fee schedules and premiums for an acceptable margin, they are also offering guaranteed cost savings.
To determine new services in a timely manner, health insurance carriers use technology tools to analyze their historical claims data and integrate that with fee schedules and actuarial data. Those without the right tools will rely on people, like accountants and technology people, to spend many more hours manually collating data into spreadsheets.
Read almost any book on managing companies in a downturn economy and you'll read that for companies to be competitive in hard times, speed, agility, and flexibility are key factors. Cigna is a good example of keeping ahead of healthcare problems. They have concierge services, such as calling households and using their claims data to target members in high risk of serious health conditions. Cigna is targeting a 2.8% reduction in medical costs for employers.
Creating these new services in a timely manner is done having the 'right' tools in place and knowing what employers want. This is more than spreadsheets populated from IT. Integrating information from various sources, like claims systems and fee schedules, is challenging. Quality of the data and knowing how to cleanse the information to make it meaningful is sometimes an art, more than a science.
Many insurers and TPAs have resources stretched thin. Asking them to work more hours and get into the guts of the data can be too much. (Not to mention employers are planning to offer flexible work hours, says Fay Hansen of Crian's Benefits).
More insurers and TPAs these days are focusing on their core business and outsourcing non-core services to companies that spend all their time specializing in web services, reporting, analysis, and document management. And many companies are considering relieving themselves of technology headaches by using internet hosting services, such as SalesForce.com. As David Cordani, COO of Cigna, says, "service is 50 percent of the reason why business goes out the window. We have to make sure our service is strong."
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