Transforming the U.S. Healthcare Payer Universe

Today's guest blog on healthcare payers comes from Dave McCament, Director, Healthcare/Payer Provider, TPI.

One of the most prominent themes to come from the recent U.S. Presidential election is healthcare insurance market reform. Candidates from both parties pointed to universal healthcare as a critical priority in a new administration.

Then the financial mess came.

While the precise form of universal health insurance coverage may not yet be determined, and this question is complicated further by the current global economic crisis, most U.S. healthcare Payer organizations are anticipating some form of mandated reform to the healthcare system.

Among the implications of proposed legislation is the creation of a National Health Information Network that would bring information technology to healthcare, making patient records available to healthcare providers anywhere.

A uniform healthcare information network forces many Payer organizations to question whether this level of adoption is technologically feasible. To be effective, a national network of health records would have to include all available data on individuals in the system - patients, institutions and practitioners alike. This is a staggering amount of data that is considered extremely private to most people. A key barrier to national network adoption and interoperability lies in whether the privacy and security of so much sensitive information can be maintained.

Security and audit compliance for patient health records is essential, but difficult to achieve. There are several factors that make healthcare organizations particularly vulnerable to data breaches. Some of these factors include:

  • Sensitivity of data.
  • Immense data flow.
  • Portability/usage of storage devices.

These issues are motivating the U.S. healthcare Payer/provider community to consider new models for enhancing the services to citizens while mitigating the risks that such transformations introduce. Outsourcing is one method that will help to achieve the competitive advantage leverage offers - whether through investments in technological solutions, service delivery organizations, or practices for purposes of consistency and integrity of operations.

There are certainly challenges to using an outsourced model for the healthcare community, but the power of leverage is formidable in the face of difficult economic circumstances.