Guest post by Craig Kasten, chairman, SKYGEN USA.
Despite all the advances in technology over the last three decades, many large health payers are still conducting aspects of their business the way they did in the pre-Internet days of the 1980s, relying on manual processes and interactions with members and providers.
That mindset can no longer continue. Between the huge influx of individual members that resulted from the Affordable Care Act (ACA) and the expectations of the customer experience members have based on their interactions with retail, telco and other industries, payers must make significant changes to prepare themselves for success in the 21st century – and beyond.
The days of sprawling campuses housing thousands of employees, acres of call centers and a labyrinth of file rooms archiving mountains of incoming paper documents are going away. Following are some of the key adjustments health plans will start making in 2016.
- Deploy robust web portals. The use of self-service web portals has become common in many industries. Consumers can go online to obtain information or complete transactions whenever they want from wherever they are using whatever device they prefer. Health plans will start making this same level of self-service available to their members and providers rather than relying solely on phone, email or snail mail. By providing more answers through online self-service portals, payers can focus call center personnel on answering more difficult, complex questions that provider higher value to members and payers while reducing their costs to deliver that level of service.
- Implement 24/7 online claims administration. Most health plans cannot afford the high level of overhead required to staff claims processing or authorization department around the clock. By implementing online claims administration technology, payers will be able to offer continuous, 24/7 processing of incoming claims and authorizations, removing delays and delivering resolution faster. They can also use these technologies to identify exceptions and pass them to the appropriate personnel for immediate review, ensuring they receive the proper attention rather than getting “lost in the shuffle” of paperwork.