Conventional wisdom says that automating key business processes is a sure way to enhance operational efficiencies and drive cost savings. However, as the Affordable Care Act (ACA) continues to transform the healthcare market, constantly maintaining and upgrading legacy automated claims processing applications is proving to be prohibitively expensive.
In response, healthcare payers are reconsidering their IT and business process strategy and, specifically, are rethinking their commitment to maintaining high levels of automation and heavily engineered custom applications. What’s emerging as a more viable alternative is a claims processing model characterized by lower levels of automation and application customization, combined with process optimization and increased levels of investment in personnel and training. Many are finding that this approach can be more productive, costefficient and flexible.
This ISG white paper examines some of the issues related to claims processing operations in the context of healthcare reform, and outlines several strategies payers are adopting to address this rapidly changing environment.