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Removing inefficiencies in American health insurance

By Kevin Adams, CEO UST HealthProof

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Removing inefficiencies in American healthcare insurance

In 2022, few things unite the American people like the belief that the healthcare is too complex and that this obstacle makes it more difficult to achieve the best outcomes.

Because a broadly popular political solution has proven elusive, a growing number of payors are embracing technology to improve efficiency and reduce red tape.

Instead of viewing reform as a zero-sum game where one side must benefit at the cost of another, evidence shows that the efficient operations made possible through a modern, fit-for-purpose technology ecosystem save on healthcare costs and create better experiences for all involved.

Identifying the Problems

In addition to high costs, America’s healthcare system is plagued by a byzantine pricing structure that makes it difficult to anticipate expenses. This serves to exacerbate the difficulty many Americans have in finding the right healthcare solutions.

According to the World Bank, the US spends 16.7 per cent of its GDP on healthcare – more than any other industrialised country and significantly higher than the 12.5 per cent OECD average.

That amounts to $11,900 per person, which far outpaces per capita spending anywhere else – even though US outcomes consistently rank near the middle of the pack.

But it isn’t just a question of economics. America’s subpar health outcomes have a real effect on our lives and on those around us, as we must deal with an unhealthier population and a lower life expectancy than peer nations.

With so many variables to consider, Americans face a high level of uncertainty.

People choosing a new health insurance plan or seeking healthcare treatment can’t clearly make sense of what their total costs will be. However, it doesn’t have to be this way.

Boosting Efficiency 

Fortunately, we already know how to solve the biggest inefficiencies on the business operations side of the health insurance business. We can remove a high level of inefficiency simply by making claims processing and other critical business operations function the way they should.

Technology plays a critical role in achieving the desired efficiency with payors that adopt a Business Process as a Service (BPaaS) approach involving combined operations and technological solutions which commit to achieving an annualized operating cost savings of 20 – 25 per cent.

With BPaaS solutions steadily becoming more capable, accessible (and most importantly) more affordable, the timing has never been better to move from outdated legacy IT systems to a modern tech-based health ecosystem.

In addition to creating savings that can be passed along to members, the increased efficiency allows health insurance companies to reallocate resources and shift their focus from operations towards care and patient engagement.

Increasing reliance on technology does more than just increase efficiency, it also improves transparency and helps make pricing structures more transparent.

By creating a fully digitised ecosystem of healthcare data, payors are able to save money, accelerate the enrollment process and increase visibility for members. It’s truly a win-win for all parties.

Real, Tangible Benefits

While the savings that comes through increased reliance on BPaaS are impossible to ignore, the benefits that are created by greater technological integration go far beyond dollars and cents.

Operational inefficiencies remain one of the biggest points of friction that healthcare plan members and providers have with insurance companies.

Eliminating these unnecessary hurdles is the most essential step towards better experiences and outcomes for everyone involved.

When executed properly, the increased efficiency of BPaaS-centric networks can be a vital component in producing life-saving results and helping patients get the critical care that they need.

Plans should also place an emphasis on these points because member-experience metrics are taking on an ever-increasing importance in CMS star ratings.

The member experience is closely tied to efficiency and is strongly correlated with member retention. Data shows that plans with more efficient operations are the ones who retain and grow their membership base while simultaneously optimizing their value-based reimbursements.

While increased reliance on BPaaS solutions isn’t that magic bullet that will singlehandedly reverse the negative trends in US healthcare, it is a perfect place to start.

After all, who is going to make a straight-faced case for inefficiency and waste? Working to integrate BPaaS into more business models will lead to positive outcomes and can provide a blueprint for greater digitization across other sectors in the healthcare space.

In fact, the same capabilities that we’ve already discussed can also be applied to the prescription insurance space (PBM).

I’ll go into more detail on the exciting possibilities here in a later submission but bringing BPaaS to both health insurance and prescription insurance capabilities will be a true game changer for overall insurance cost reduction.

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