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Healthcare Software Systems in the ACA Era

Healthcare organizations, particularly insurers, are feeling squeezed from all sides. The number of mandates being passed by the federal government is rising but the solutions being offered by the insurance software vendors are still limited in number. 

Payers are seeking healthcare software systems that are agile and intelligent and can ensure compatibility with the health care reforms.
Private Health Exchanges AriseWith the arrival of state and federal exchanges, many payers are feeling pressured to develop their own private health exchanges that won’t be regulated by the federal government but will function in a pretty similar manner. As a result, the need for finding healthcare software systems that can ensure profitability along with ensuring transparency and regulatory compliance has taken centrestage.
The need is to find healthcare software solutions that offer a greater degree of automated functions, including acquisition or health care enrollment. This should be combined with automated CRM or Customer Relationship Management. The vendor should be able to offer some window for customization. This is because most of the bigger payers need to incorporate their business objectives into the automated processes and ensure that operational costs are reduced.
Payers that are planning to create their private exchanges, individually or in coordination with other insurers, are seeking software solutions that are future-ready, i.e. ensure compatibility with any other change mandated by the HIPAA, and can offer additional features like fraud case management.
Need for Better Healthcare Insurance Software SolutionsThe ACA-mandated insurance market is going to be more streamlined which means that payers need to reduce their program cycle and still be able to offer features like an insurance quote engine. Payers are still adjusting to the new rules where the insured cannot be denied coverage based upon pre-existing condition, age, employment status, etc. Thus, a new and improved Claims Manager is an integral part of any proposed medical insurance software solution.
With the ACA ensuring greater benefits to employees and smaller employers, Employee Benefit Management takes upon greater importance. This includes automated calculations of workers’ compensation, leaves, type of leaves, employer insurance and out-of-pocket expenses. Essentially, most of the industry players are seeking all-in-oneFree Reprint Articles, browser type of an application where it becomes easy to view critical patient data and take important decisions regarding claim

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ABOUT THE AUTHOR


Author is an expert in the emerging U.S. exchange marketplace, systematically following trends emerging from the niche of Private Insurance Exchanges and Health exchange navigators



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