Insurers are shaping their business strategies to grow and to operate smarter ahead of the Jan. 1 go-live date for many provisions of the Affordable Care Act.
Several key trends especially affect the health insurance industry, including preparing for non-traditional business models, according to SunGard, a software and IT services provider.
"Health payers' new business strategies are driving the need to streamline business processes and react quickly to capture new revenue streams," said Paul Tiede, executive vice president of SunGard's insurance business in a news release Monday.
Including meeting time-to-market requirements, more communications with members and providers, and holding down administrative costs, the trends are:
1. Increasing pressure on profit margins and manual processes drive the need to gain efficiencies in financial accounting, investment management, and claims processing.
2. Insurers are driving industry consolidation to diversify revenue sources and growth in new markets, such as increasing their Medicaid business through acquisition of niche players, focusing on the individual consumer market, and expanding into more states.
3. More states are shifting the management of their Medicaid plans to private sector managed care plans, enabling states to reduce risk and cost.
4. The expansion of accountable care organizations require innovation by connecting providers, facilities and payers to form an electronic, patient-focused model, simplifying claims processing, and establishing incentives for healthy patient behavior.
5. As health insurers change their business models, they need to modernize their processes and data, reduce costs, and manage and automate regulatory and service level compliance, while supporting ICD-10 and other strategic initiatives.