FRAMINGHAM, MA - Although top U.S. healthcare payers reported pricing transparency initiatives in 2007, they face challenges in 2008 that will limit information technology investments in this area.
A study conducted by Health Industry Insights in June, surveyed 79 of the largest and most active of U.S. healthcare payers in both business and technology innovation and investment. The study examined investment and execution priorities, strategies, barriers and likely future trends through 2009.
The report, entitled Financial Transparency: Healthcare Payer Strategies and Execution 2007-2009, revealed key findings in the areas of online claim payment and adjudication, cost and quality information and transparency investments. Janice Young, Health Industry Insights' program director for payer IT strategies, wrote the report.
According to Young online and real-time claims adjudication and payment is the cornerstone of transparency initiatives.
The report also reveals that, although there are challenges in providing reliable, comparable cost, quality and outcomes information, 64 percent of healthcare payers surveyed reported some cost and quality transparency initiatives in 2007.
Other findings from the study include:
•35 percent of healthcare payers surveyed indicated that they had current initiatives to implement on-line real-time claims adjudication across their enterprise.
•19 percent of healthcare payers who had planned real-time adjudication initiatives actually implemented strategies in 2007.
•18 percent of healthcare payers indicated that they had plans to implement real- time adjudication by the end of 2009.
Despite the consumer and employer demands, the report found that challenges with data availability and accuracy and questions about usability, privacy and security would limit transparency investments in 2008.
Of the healthcare payers surveyed, 53 percent planned no additional investments in 2008. Instead, healthcare payers said they would be assessing the effectiveness and return on early initiatives to identify best practice industry models.
"As the healthcare market and healthcare payers move beyond the hype and the façade of information transparency in 2008, they must and will shift investment from presentation to greater investments in the business and technology infrastructure to support credible, accurate, comparable, and accessible data," Young said.