HealthEdge, a software provider that helps healthcare payers by focusing on claim processing benefit administration, business intelligence and portals, released the results of its latest State of the Payor survey:
• "76 percent of payors are considering adoption of an ACO model"
• "80 percent of payors are evaluating emerging individual exchange opportunities"
• "Only 61 percent of payors believe they will be ready to meet the new ICD-10 compliance deadline"
• "52 percent of payors report that any ICD-10 delay will have limited financial impact on their businesses"
Ray Desrochers, executive vice president at HealthEdge, explains it like this:
"The Supreme Court's decision on the Patient Protection and Affordable Care Act (PPACA) reinforces the need for change. Our survey shows that the payor industry understands that business as usual is no longer a viable strategy as we move to new business models that increase member involvement, reduce unnecessary costs, and increase the overall quality of care. Huge opportunities are available to payors who can adapt to the rapidly changing healthcare marketplace and execute better than their peers. One way to accomplish this is to leverage modern technology to offer a new generation of innovative products, operate more efficiently, and provide the data to determine which models actually lead to better outcomes and lower costs."
This survey reinforces a couple points that DesRochers covered in an interview last month.
ICD-10 readiness
First, he told me that a majority of healthcare payers surveyed were on track to meet the Oct. 1, 2014 deadline. I guess 61 percent is a majority, but it's not enough to instill confidence in a smooth transition. And he was adamant that another delay is not an option. All healthcare organizations need a rock-solid deadline to get this done.
He also thought any optimism about meeting the ICD-10 compliance deadline was largely due to underestimating the scope of the problem and needed solutions.
The bigger picture
Second, there is more at stake than upgrading medical codes. Healthcare payers are planning for business models that will be driven by the ACA and an industry-side movement to cut costs.
This was an area that Desrochers couldn't talk enough about. He is adamant about preparing for new ways of doing business. "ICD-10 is but one of many things going on in healthcare right now. It's but one of many changes that they will have to react and respond to if they are going to successful in this new healthcare economy,"he told me.
Stay tuned
This is just a preview of the survey. More information is coming. Hopefully it will give us a clear image of the state ICD-10 readiness.