Retail evolution hinges on efficient technology

June 1, 2007

At the center of the supply chain, health plans and their IT systems are uniquely positioned to guide the "retail market" interactions. To do so, however, health plans must rethink their traditional roles.

At the center of the supply chain, health plans and their IT systems are uniquely positioned to guide the "retail market" interactions among consumers, providers, employers, and brokers. To do so, however, health plans must rethink their traditional role as "administrative scorekeepers" that simply take in revenue and pay out claims.

To provide value, health plans will need to evaluate healthcare through the eyes of their constituents-those who consume, provide, and finance care. With this approach, the health plan can begin to leverage technology to enable all constituents to conduct business effectively. What is critical is a comprehensive set of technologies known as the consumer retail platform that the health plan can use to transact business and manage relationships with these various groups. Given the complexities of healthcare technology, this platform will need to meet an even broader range of constituent needs.

Informed consumer

With the appropriate tools and information, healthcare consumers can make educated decisions on health and wellness. Tools provided by the health plan can enable consumers to:

Cost crisis for employers

Unless current trends change, employers' healthcare costs will double in nine years. That statistic is already significantly impacting employee benefits, with some employers reducing or dropping health coverage, and others offering high-deductible benefit plans.

Given these factors, health plans need to implement various value-added products and services to assist employers, as well as their employees, who must cope with the increased responsibility of their healthcare choices. For example, employees will need innovative tools to compare benefit plans and enroll online. Online billing and payment options for employers will also be critical.

Health plans can play a key role in helping employers manage employees' health by providing:

Providers and bad debt

As consumers shoulder more of their healthcare services costs, providers face a potentially crushing load of growing accounts receivable and bad debt. Determining the accurate amount a patient owes for these services-in real time and at the point of care-will drive the most profound changes experienced in the U.S. healthcare system over the past several decades. These changes will involve consumer behavior, as well as health plan and provider relationships and costs.

Many plans are also implementing pay-for-performance programs that reward providers who meet quality and cost standards.

Overall, health plans can effectively collaborate with providers by investing in technologies that facilitate: