Legacy tech dragging down new health models

By BenefitsPro

By Kathryn Mayer

Technology might be a solution for a lot of businesses, but it also could be a problem — especially when it’s outdated and inefficient.

A new survey from HealthEdge, a software vendor, shows health care payors are struggling with outdated tech solutions as they explore new ways to compete in the rapidly evolving health care marketplace.

The survey of more than 100 health care industry execs from across the country found a “growing desire among payors to evolve their businesses and adopt next-generation health care business models.” But, at the same time, many respondents said their existing systems won’t effectively support new plan designs, payment reform approaches and increased organizational transparency requirements as well as a number of other key goals.

According to the survey, 78 percent of payors want to expand Medicare and Medicaid participation; 71 percent are exploring pay-for-performance initiatives; and 61 percent want to jump in accountable care organizations.

But many payors aren’t prepared to address the technological requirements of these new models, the survey found.

For example, though payor interest in ACOs is high, 47 percent of respondents said they don’t have the technology required to support them. Similarly, 61 percent of respondents said they don’t have the technology required to support next-gen consumer-directed health care plans, and another 52 percent face the same challenge when trying to support value-based benefit designs.

Though the results to move forward are “encouraging,” Ray Desrochers, executive vice president of sales and marketing at HealthEdge said, “much work still needs to be done to ensure payors are technologically ready to support these important new initiatives.”

Many payors also said they’re paying too much for “costly manual processes to handle transactions not supported by their legacy systems.” More than half of respondents (55 percent) said they’re automatically adjudicating less than 80 percent of claims, while 61 percent said they’re paying $6 or more to manually adjudicate each claim.

Originally published on BenefitsPro.com