Tag: healthcare payers

Key RIMS Observations and Their Industry-Wide Implications

Guest post by Mitch Freeman, chief clinical officer, Mitchell International, Pharmacy Solutions.

Mitch Freeman
Mitch Freeman

Another gorgeous San Diego spring, no surprise there. Another enormous RIMs convention hall packed with Insurers, TPAs, and service providers, no surprise there either. San Diego is probably the most prime location for this venue of all. Convention hall on the waterfront, luxury accommodations, views of the harbor and Coronado, a teeming Gaslamp district keeping the attendees in tight proximity for after-conference networking with great food and libations, what could be better?

I’m a believer that the terms like “changing,” “different,” or even “same” should not imply the assumptive application of the terms “better” or “worse.” Plainly said, I observed a few notable differences or trends with this conference that I have not seen in the past and that has no bearing on the conference being better or worse than previous conferences.

WC service providers are less prominent in the overall convention

RIMS has always been a conference heavily attended by workers’ compensation insurers and TPAs “WC payers.” This is the conference where WC payers get the chance to meet with prospects or existing customers and win new business, or solidify existing relationships. WC service providers offering pharmacy benefits management (PBM), medical bill review, and ancillary services have historically exhibited in hope to network with the multitude of attending WC payers. This year, there were noticeably less prominent booths from WC service providers and some chose not to exhibit at all.

Why?

A recent shift has occurred from the “good ole days” of relationship-based selling to selling on value. Payers are more focused on what a service provider actually delivers than how much they wine and dine, all be to an extent. Furthermore, many contract decisions are now being driven by procurement departments within payers. That’s not to say that relationships within the industry are not still important, it just means that exhibiting is a less critical component of the recipe to winning or retaining business.

Property loss prevention is filling the void

I observed far more property loss prevention service providers than I have ever seen exhibiting at RIMS. There were several flood recovery providers present, ServPro and their competitors. I experienced first-hand virtual reality by donning “Oculus Rift” type goggles and toured a research facility where the company can essentially recreate your building and burn it in front of your face in 3-D. This type of marketing push outside of WC has not been seen before at RIMs.

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Technology Helps Payers Transition for the Future

Guest post by Craig Kasten, chairman, SKYGEN USA.

Craig Kasten
Craig Kasten

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.

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