Healthcare, as we know it, is changing rapidly. The key trends defining the industry include a seminal shift to value-based care, rise in consumerism, and regulatory uncertainty. As the industry navigates these changes, it also has to struggle with challenges such as siloed operations, fragmented member data, and legacy IT estates. With the emergence of digitalization, payers are realizing the undeniable need to leverage IT advances to deliver better care outcomes and remain competitive.
In this viewpoint, we showcase the current state of payers, the need to modernize, and the urgency of adopting an as-a-service IT platform model to enable true digital transformation. We assert that payers need to adopt this approach to help restructure their cost models and take a consumption-linked approach to modernization.
Scope
Industry: healthcare payer
Geography: US
Contents
In this paper, we:
Examine the state of payers across the financial distress and technical debt dimensions
Analyze the key challenges in the way of digital transformation and a suitable approach to transformation, and discuss the benefits of a platform-led approach and the relevance of affiliate partner models to navigate change
Solve the cost conundrum by outlining value drivers and a case-based analysis of different services models
Establish the business case for an as-a-service IT platform
Map the journey and institutionalize the roadmap for change
Health insurance claim denials cost payers and providers over US$300 billion every year. Other than the financial loss, both the payers and the providers incur additional administrative burden, increase A/R cycle, and loss of member goodwill. Take…
