In the two years since the Patient Protection and Affordable Care Act's passage the health care industry has seen a flurry of activity. And much of this activity has been around technology innovation related to health insurance exchanges, but there are other technologies in the works as well. Here is a retrospective on the last two years of technology innovation, which also serves as a good indicator of where technology will likely be going in HIT as it may relate to PPACA.
Health insurance exchanges (HIX). Private, public, proprietary. Federal, regional, state. Individual, family, small group, large group. There is no shortage of ideas or approaches. Even if PPACA dissolves, the concept of health insurance exchanges will continue to evolve and may well transform our industry.
User experience (UX). Getting people to consistently and proactively take control of their health and welfare has been difficult. With PPACA, there is no shortage of ideas or initiatives about how to best help consumers/employees make more educated decisions about their health care. And all solutions have to factor mobile devices into the equation.
Brokers. The value of brokers in the health care supply chain has been reaffirmed. Many innovators have recognized this and continue to create new tools for the broker community. Brokers too are participating in finding new ways to use technology to enhance their value and deliver on the promise of change.
Social. The unstoppable advancement of social software is changing the world as consumers and individuals become empowered and more interconnected. A variety of technology solutions seek to leverage social software capabilities to advance health care in all areas: HIXs, the user experience, wellness, education, cost transparency, quality and more.
Cost transparency. One of the missing pieces for consumer-driven health plans has been access to the cost of health care (before the delivery of services). The push to give consumers more control over their health and welfare has been hampered by the lack of cost transparency. Multiple solutions have emerged; each offering a unique take on empowering employees with cost and quality information of medical procedures in their health plan and in their geographical area.
Quality rating information. Assessing the quality of medical care is much more difficult than that of goods or services in other industries. Because quality information is hard to come by, cost is often used as a substitute; high cost equates to high quality. In other industries the cost and quality curves are more directly linked than they are in health care.
Wellness. Improved outcomes. Better disease management. Targeted incentives. Wellness programs have been around for a while now, but achievement of consistent ROI has been lacking. Tying incentives to outcomes has led to more options for employer groups. The results are programs that impact health care spend while improving employees' lives at the same time. Moreover, broader approaches look to expand beyond employer groups into communities of users.
Defined contributions. In an effort to reduce exposure to rising health care costs, businesses are increasingly looking at DC plans. In these plans companies pay a fixed amount for an employee's health insurance. The current model is defined-benefit plans where companies select the health insurance benefits offered. The trend toward DC plans will continue to accelerate, along with CDHPs and cost transparency tools.
Client relationship management. CRM tools for brokers are becoming more widely used as vendors provide capabilities specifically for the group health market. Workflows to manage the RFP process are becoming more sophisticated, allowing brokers to meet the dynamic needs of potential and existing clients.
This list of areas of change is not exhaustive; there are other areas where innovation is occurring (like provider systems and electronic health records). I for one am very glad to be a part of the technology community that is helping to redirect the course of health care in America.
Lamb is vice president and group head of the EbixBenergy business unit at Ebix Health.
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