1. Market Research
  2. > Internet Business
  3. > E-Healthcare Market Trends
  4. > Payor Involvement in the New Healthcare IT 

Payor Involvement in the New Healthcare IT 

  • March 2014
  • -
  • Frost & Sullivan
  • -
  • 6 pages

2013 proved to be a year of tremendous rethought on traditional payor roles in various emerging models for care that involve varying levels of consumer participation as well as more capitated setups that limit payment for plan-supported provider billing. Most industry thought leaders on both sides are convinced that IT infrastructure development to support these initiatives will form a key part of post-Affordable Care Act (ACA) reimbursement programs starting in 2015, provided such consensus can be
implemented evenly across the board.

What are the Main Restraints on Payor-Based IT Investment?

Frost & Sullivan believes that the three main temporary restraints on greater investment in next-generation IT systems are:
• Implementation and deployment speed around “business essential” billing and collection systems;
• Actual sales for capitated model designs to the core large employer market; and
• Cooperation to support next-generation population analytics to decrease overall member utilization and member satisfaction services.

The speed of policy change does not evenly match deployment times and infrastructure cost for systems that support those broad changes. For example, the annual industry service cost of traditional billing and collection automation approaches approximately $1 billion in total industry integration, with up to two months of closed-loop integration to existing legacy claims processing systems per buyer.

Add to this that only about 60% of all national claims are truly automated, with bi-directional exchange of claims payment requests, semi-real time adjudication of submitted claims, patient plan verification, and actual accounts payable log and provider payment. Current billing and collections rely heavily on prompt clear-out of accounts payable, so backlog created by the adjustment process to automated systems can be cost-prohibitive to the payor system. Capitated models in the private sector, such as value-based design, Medicare-style accountable care, and defined contribution plans, all require a deep degree of employer and provider buy-in to justify a systems transition instead of simply migrating internal service processes such as claims processing. To date, at the end of 2013, there was substantial surveyed interest in defined contribution structures but fewer actual sales across the industry in the over 1,000 employer market.

There is also the assumption of consumer risk acceptance and behavioral change through the creation of an array supplemental member health tools and services, all of which require infrastructure investments in mobile health, wellness and wellness-related tools and services, and medically verifiable health tracking tools. Many payors speculate that utilization of such “deep” medical services will be far greater when offered at the consumer or provider levels, so there is hesitation in placing a large bet on such tools right now.

Table Of Contents

Payor Involvement in the New Healthcare IT 

View This Report »

Get Industry Insights. Simply.

  • Latest reports & slideshows with insights from top research analysts
  • 24 Million searchable statistics with tables, figures & datasets
  • More than 10,000 trusted sources
24/7 Customer Support

Talk to Ahmad

+1 718 618 4302

Purchase Reports From Reputable Market Research Publishers
EU5 Clinical IT Systems Market Outlook to 2022

EU5 Clinical IT Systems Market Outlook to 2022

  • $ 5995
  • Industry report
  • November 2016
  • by Global Data

EU5 Clinical IT Systems Market Outlook to 2022 Summary GlobalData’s new report, "EU5 Clinical IT Systems Market Outlook to 2022", provides key market data on the EU5 Clinical IT Systems market. The report ...

Asia-Pacific Clinical IT Systems Market Outlook to 2022

Asia-Pacific Clinical IT Systems Market Outlook to 2022

  • $ 5995
  • Industry report
  • November 2016
  • by Global Data

Asia-Pacific Clinical IT Systems Market Outlook to 2022 Summary GlobalData’s new report, "Asia-Pacific Clinical IT Systems Market Outlook to 2022", provides key market data on the Asia-Pacific Clinical ...

Telehealth Market by Component, Software, Services, End User, & Mode of Delivery - Global Forecast to 2021

Telehealth Market by Component, Software, Services, End User, & Mode of Delivery - Global Forecast to 2021

  • $ 5650
  • Industry report
  • December 2016
  • by MarketsandMarkets

The telehealth market is projected to reach USD 9.35 billion by 2021 from USD 2.78 billion in 2016, at a CAGR of 27.5% in the next five years (2016 to 2021). The healthcare industry is undergoing a fundamental ...


Download Unlimited Documents from Trusted Public Sources

Healthcare IT Industry in Canada

  • February 2017
    6 pages
  • Healthcare IT  

    Influenza  

    Hospital  

  • Canada  

View report >

Healthcare IT Industry in Canada

  • February 2017
    6 pages
  • Healthcare IT  

    Influenza  

    Hospital  

  • Canada  

View report >

Healthcare IT Industry in Canada

  • January 2017
    6 pages
  • Healthcare IT  

    Influenza  

    Hospital  

  • Canada  

View report >

ref:plp2014

Reportlinker.com © Copyright 2017. All rights reserved.

ReportLinker simplifies how Analysts and Decision Makers get industry data for their business.