As health plans modernize their technology to better manage changes brought about by health reform legislation, they will transition from legacy systems that focus on internal data repositories to a more collaborative, outward-facing patient-centric model that integrates electronic health records (EHRs), personal health records (PHRs), health insurance exchanges, customer relationship management systems, and analytics technologies.
"For IT vendors providing technology solutions to health plans, the scope and breadth of their solutions and services have just exploded, and that means for them huge investments in either new applications or functionality or new partnerships or acquisitions," Janice Young, IDC payer IT strategies program director, told InformationWeek Healthcare.
Young, author of recent IDC report "Business Strategy: Care is the New Core--Healthcare Payer Top 10 for Health Management in the Reform Decade," said more traditional vendors like McKesson, MEDecision, TriZetto, and new market entrants like Casenet, ZeOmega, Click4Care, and IkaSystems have invested or are moving to open platform strategies.
These companies currently support or are working towards offering service-oriented architecture (SOA), Web services integration, user accessible and configurable business rules and workflow, and cloud computing systems.
"They are grappling with managing the shift from care and case management toward shared information and ... a more collaborative environment." Among the questions they are asking themselves, according to Young: "How deeply into informatics and business intelligence are we going to go? To what extent will we support applications that actually share the information and the business processes, such as patient portals to the consumer or health information exchange initiative?"
According to the report, health reform legislation, competition for new customers, and the desire to reduce costs all contribute to the need for a new business model in the healthcare payer market during the next few years. These trends are documented in surveys conducted by IDC Health Insights in recent years.
"U.S. healthcare payers report investment priorities shifting from the traditional core administrative applications to care and business intelligence solutions. Fewer than 50% of healthcare payers surveyed indicated planned new investments in the traditional core administrative (claims) solutions in 2011. In 2009, healthcare payers surveyed by IDC Health Insights listed care management as one of the top 3 investment categories and also the top driver of business intelligence and actionable analytics investment," the report stated.
To meet the growing demands of the market, health insurance companies will begin to align and integrate health management with customer relationship management (CRM) strategies. IDC also predicts further investments in health and wellness program processing applications that use predictive modeling analytics to identify patterns and trends in patient care data, which will enable health plans to make faster, better decisions and assist providers with clinical performance reporting.
Among the top changes expected in the next five years, according to the IDC Health Insights report:
-- Cost management, information, and agility market drivers will compel technology platform updates;
-- Care management solutions will integrate health and wellness;
-- Vendors will invest in 360-degree consumer engagement, health, and management tools;
-- Clinical analytics will be integrated with health management;
-- CRM will be aligned with health management strategies; and
-- Health management tools will be integrated with communications technologies, workflows, and analytics.
Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)