Introduction
Traditionally, the primary role of health care organizations has been the delivery of health care services to the public. However, over the last few decades several changes have occurred in the medical field that requires health care organization to develop new ways of enhancing the quality of service delivery. For example, the current generation is more aware of health issues than it has been the case in earlier decades. At the same time, there are more chronic and life-threatening diseases and conditions affecting populations across the nation and the world in general than it was the case in history (CGI, 2014). Further, there has been the economic integration of health care organizations by governments and non-government agencies to improve the quality of care to all people. For example with the implementation of the Affordable Care Act, HIPAA rules, and regulations, healthcare organizations have been encouraged and required to use relevant information to improve their ability to deliver health care services to the public.
Most of the challenges have resulted to medical insurance which is one of most critical assets for patients. It is essential to note that efficiency in health care insurance decisions relies on the availability of accurate information from health care organizations (EY, 2015). The inadequacy of the same results from wrong decisions by the insurers and at the same time failure of claim payments to the insured. In a time where there are rising health care cost it is imperative that efficient information systems are developed and implemented to ensure sufficient information from health care organizations in making decisions about health care insurance. In this light, this paper will focus on demonstrating some of the information technologies that have been directed at solving issues in health care coverage.
Trends in Healthcare Insurance
It is vital to discuss some of the challenges and changes that have been taking place in medical insurance that have necessitated the need for better information systems in both health care institutions and health insurance companies. To begin with, there has been a trend of rising cost of health care over the last few years, most of which have been caused by economic position of the country. At the same time, there has been development and enforcement of a wide range of rules and regulations in health care that have directly led to the increase in health care costs (CGI, 2014). A good example in this case includes the adherence to the Affordable Care Act as well, like the HIPAA rules and regulations. Another significant trend that has affected the affordability of health care and insurance is the cost inflation by pharmaceutical companies that have led to an increase in the cost of drugs across the country.
The companies have been found to charge a high price for pharmaceutical products, which has, in turn, led to increasing health care and insurance costs. When it comes to employees, there have also been issues as far as health insurance is concerned. Notably, there have been ongoing negotiations between large employers and insurance companies to charge lower insurance premiums. Apart from these, there have been deliberations to change reimbursement models as well as risk-sharing arrangements between employees and employers (Wagner et.al, 2012). In the wake of these trends and challenges, various types of cutting edge information technologies have been developed to solve most of the issues or problems that occur in the link between health care organizations and health insurance providers. Some health insurance institutions have already put some IT systems in place to improve the operational efficiency of various medical insurance plans and enhance the effectiveness of communication between insurance providers and health care organizations.
Improving Communication between Healthcare organizations and Insurance Providers
Insurance companies rely on the availability of information to be able to make payment decisions following placement of claims by the insured. As such it is crucial that health care organizations provide accurate and most up to date information on health insurance companies. Electronic Data Interchange (EDI) is one technology that has been effective in solving the problem of information sharing between health care organizations and insurers (Rushing, 2013). Basically, EDI technology refers to a system where standard data can be remitted from one entity to another using internet and computer facilities.
The acquisition of such technology that facilitates the exchange of information can enable health organizations to send insured patients medical records to their insurance providers for scrutiny in the case the latter place a claim. At the same time, in the case where the insurance companies are required to pay for patients medical expenses, payments are made with more efficiency. EDI can, therefore, transform the way health care organizations and insurance providers communicate notably by increasing the speed of communication as well as establishing a platform for real-time communication (Wagner et.al, 2012). Employing this system in an organization would improve the efficiency of managing patient’s claims and patients’ bill payments.
Electronic Medical Records (EMR) is one form of EDI that has been in the pilot stage in the last few years. The technology facilitates the transfer of patients’ medical records or history from one entity to another as far as the transfer is permissible under the HIPAA rules and regulations pertaining patient safety and confidentiality. This form of EDI can help solve a broad range of information asymmetry that affects the link between health care providers and health insurers. EMR are specifically advantageous when patients transfer from one medical provider to another (Wagner et.al, 2012). With EMR, it is possible to transfer all the medical records of such patients from one institution to another, at the same time EMR facilitates the transfer of the medical records to a new insurance provider in case patient chooses to change their insurance provider. As such, errors that would occur such as the loss of patient medical records are effectively avoided with the use of EDI systems such as EMR.
Another technology that has quickly been adopted by health insurance provider is the replacement of manual methods of keeping records with computer-based technology. Computerized methods of record keeping facilitate automation in data retrieval and also ensure the safety of patient data from access by unauthorized parties as well as from loss. One of the breakthrough technology based on computer use has been the use of Document and Content Management technology in filling patients’ information and maintenance of the same (Rushing, 2013). This technology not only makes is safe to store patients records but reduces the room for errors which are a characteristic of manual filing of patient records. The accuracy of information facilitates the availability of accurate information to insurance providers, which they use when making insurance claim decisions.
Notably, with the implementation of the HITECH Act, most health insurance companies are quickly gaining the momentum of replacing paper-based systems of records keeping which have been deemed as intensive and time wasting. As such, with more efficient computer-based technologies of data storage and management, health insurance employees can deal with more pressing matters such as determination of the validity of insurance claims placed by their company’s clients. Further, it will reduce the time taken when determining the suitability of a person seeking to take an insurance plan, as well as processing of payments when an insured person faces a health condition. The adoption of technology is assumed to improve the effectiveness of different players’ ability to share information and adopt modern practices, which are essential in the modern day.
On the issue concerning the challenge of rising cost in health care provision, there has been the development of computer-based technologies that can match the expectations of the public on what the insurance providers can cover in the incident of various health risk covered. Such computer programs will provide a perfect solution to both the insurance companies that have been losing clients due to rising medical cost including the escalation of medical insurance premium and the public by increasing their affordability for health plans (Ngafeeson, 2014). At the same time, such programs are meant to lower the cost of processing insurance claims for clients which will go a long way in encouraging more people to subscribe to health insurance plans. As such, one can argue that the adoption of modern technologies in the health care sector will facilitate the improvement of efficiency, which will have an implication on the cost, which is expected to reduce. Further, the growth in the number of mobile phone users in the nation as well as around the world, health insurers are focused on developing support programs where customers can access and manage their health information at their comfort.
As a conclusion, the adoption of modern technology in the health care sector is expected to improve the efficiency through improved exchange of information between different organizations operating in the sector. The increased adoption of electronic data interchange has been perceived as a major aspect in enhancing the ability of organizations to exchange information concerning different issues that affect the sector. At the same time, by having such a technology, it can provide relevant information to the company’s clients concerning health issues or development in premium payments. Further, this creates a stronger link between the health insurance companies and their customers.
References
CGI Group Inc. (2014, May 13). Healthcare Challenges and Trends. Retrieved from https://www.cgi.com/sites/default/files/white-papers/cgi-health-challenges-white-paper.pdf
EY. (2015, April 4). The Future of Health Insurance. Retrieved from http://www.ey.com/Publication/vwLUAssets/EY-the-future-of-health-insurance/$FILE/EY-the-future-of-health-insurance.pdf
Madison Ngafeeson. (2014, August 10). Healthcare Information Systems: Opportunities and Challenges. Retrieved from http://commons.nmu.edu/cgi/viewcontent.cgi?article=1012&context=facwork_bookchapters
Rushing, W. A. (2013). Social functions and economic aspects of health insurance. Boston, CO: Kluwer-Nijhoff Pub.
Wagner, G., Reichertz, P. L., Masè, E., & Salutis Unitas (Organization). (2012). Technology and health: Man and his world : a Salutis Unitas contribution to an international conference on medical informatics, Riva, Italy, April 21-25, 1980. Berlin: Springer-Verlag.
