After Burwell, 4 Prime Health Insurance IT Concerns

Until King v. Burwell was settled today – and the Supreme Court affirmed the legality of health insurance subsidies nationwide – health insurance IT was in a bit of a holding pattern. After all, with the potential for a “death spiral” of escalating premiums in a majority of states, it was difficult to rationalize any large enterprise product with so much uncertainty about the stability of the market.

“That uncertainty freezes people,” says Michael Trilli, an Aite Group analyst covering the health insurance industry. “Now that the [expanded] individual market seems like it’s here to stay, there’s lots of places to go.”

Trilli identifies four key areas of IT investment to which health insurers can turn their focus:

Customer experience – Health insurers have more direct connection to their customers than ever before, and it’s imperative that they continue to add value to the insurance product through digital channels.

“First and foremost, it’s the consumer engagement: How do you support that engagement through more services for members, beyond ‘what are my plans and ‘how do I see my claims,’” he says.

One potential avenue is deeper integration with the payment systems at healthcare providers so that insurance customers can pay their additional costs that aren’t covered by insurance through the insurer’s site. That way, instead of a customer having to pay multiple bills through multiple channels, they can use the insurer’s site as a one-stop shop for payments.

“Health plans have done a pretty good job of rethinking what services they want to make available to their members, but that has stopped at the point of payment,” Trilli says. “But it’s a good way to keep them on your site and keep them coming back.”

Provider relationships – Payments aren’t the only place insurers need to ramp up their integrations with the technology systems at providers. The move to value-based care means it’s more crucial than ever that data exchange between payer and provider is clean and easy, Trilli says.

Legacy replacement – Though Cigna spurned Anthem’s bid to acquire it this week, consolidation is coming to the health insurance industry – and with it, a need to revamp health insurance core systems.

“If these big acquisitions come to fruition, they have to be thinking more about platform consolidation and upgrades,” Trilli says. “It’s about vetting what kind of claims platform will work for you in 2020.

Cybersecurity – Finally, Trilli says, after a number of high-profile breaches this year, health insurers should continue to be vigilant on protecting customer data.

“It’s not just because of the breaches, either,” he says. “These organizations, at their heart, are handling sensitive data – and it’s always an imperative to keep that safe.”