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Health Insurance Information Technology: US Overview and Outlook, 2014-2020 

Health Insurance Information Technology: US Overview and Outlook, 2014-2020 

  • November 2015
  • 134 pages
  • ID: 3384815
  • Format: PDF
  • Frost & Sullivan


Table of Contents

Health Insurance Information Technology: US Overview and Outlook, 2014-2020

Key Findings—Study Highlights

Today, healthcare payers are grappling with a number of significant challenges that are upending their traditional business models and operational processes.

- A plethora of new regulations and compliance obligations as a result of the Affordable Care Act (ACA); continued cost inflation driven by healthcare providers, pharmaceutical companies, and technology vendors; consolidating providers and large employers getting tougher on payer contract negotiations; and the rise of individual consumers demanding a higher level of service at lower premiums are just some of issues causing real angst among payers.

- Added to the mix is the new experimentation with changing reimbursement models and risk-sharing arrangements which will require new ways of working with and sharing information with healthcare providers.

- To tackle these many challenges, health plans are actively looking at information technology as a lever of operational efficiency and transformational change, with spending priorities focused on new tools for analytics, consumer engagement, and population health/care management.

- IT vendors serve a central role in helping payers to better leverage their vast claims data resources, bringing these data together with clinical, financial, socio-economic, and other data generated across the health ecosystem to create robust data sets that can be used to improve the quality and efficiency of healthcare and create new innovative tools to engage consumers.

- While total IT spend for the health insurance industry is expected to grow in line with premium growth reflecting a surge of new covered lives due to ACA, Frost & Sullivan predicts that the industry standard percentage of total premium devoted to IT will not significantly increase overall due to growing margin pressures and the need to contain rising administrative costs. Rather, the allocation of spend among various IT segments (infrastructure/hardware, core administrative systems, BI/analytics, and consumer engagement) will shift to focus on new business priorities arising from shift to consumer focus.

Key Questions This Study Will Answer

- How does the US health insurance system operate and what is the role of various information technology (IT) products and services that are deployed within the system?
- What are the market-shifting macro trends impacting the health insurance industry today?
- What are the specific drivers and restraints impacting the market for IT solutions used in US health insurance companies over the next 5 to 6 years?
- What is the 6-year revenue outlook for IT solutions deployed by health insurance organizations?
- What are the key competitive characteristics for IT vendors serving the market?

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