If the U.S. House of Representatives’ narrowly passed American Health Care Act become law, health insurance companies will need to update their information infrastructures, including their communications, compliance and analytics capabilities.
First and foremost, health insurers will have to shore up digital communications, says Ben Isgur, leader of PwC's Health Research Institute. While there obviously will be many changes to health insurance coverage, the biggest reason to have open lines of communication is the penalty for lapses in coverage, he explains.
"What kind of robust capabilities do you have around apps and mobile strategies, auto-reminders and text reminders, all of the different types of communications yo do with members, trying to encourage them to stay on?" he asks. Rather than the federal government encouraging health-insurance purchasing through the tax code, "insurance companies will become more responsible around what would happen if coverage lapses."
On the back end, health payers will need to invest in analytics platforms to help get a fuller view of their membership, Isgur continues. That way, payers will be able to rework their pools to line up with some of the new provisions in the ACHA. For example, the subsidy system to help policyholders pay for insurance will change from income-based to age-based.
"It's about trying to understand your membership from the actuarial viewpoint, and putting together the right scenarios as to what the population will look like, how will they spend, who's more likely to let their policies lapse," he explains. "There's going to be some changes in terms of premiums around age bands, and a lot of analytical analysis, goes into projecting how medical costs will trend."
He also notes that states will have much more flexibility under the law, which may mean that insurers potentially will have to make differing accommodations depending on where they are doing business.
"That's going to mean that insurance companies now may have different operating requirements state by state," he says. "That would even affect the employer insurance market."
How states react is surely going to affect one of the key digital components of the ACA: the health insurance exchanges. Their fate is unknown, but with certain states healthier than others the upshot is that insurers will face a patchwork of potential solutions to work with. That could invalidate work that was done for the original exchanges and require new back-end integration work.
"In the short term they will continue to struggle and it remains to be seen if states can draw customers based on new rules, but all signs point a longer term renaissance with states having more responsibility and insurers selling over state lines," says Michael Trilli, senior analyst for Aite Group.
Trilli agrees that most tech spending will be on updating systems for the new law.
"Overall, I see the bigger investments on the business side and ultimately how will technology support those such as selling over state lines. The biggest tech investments will be unwinding/changing requirements built for ACA to this new plan."
