It’s a rough time for healthcare payers in the US with tightening federal and state regulations, cost and time pressures and having to make do with outdated IT systems that fail to deliver modern technology benefits. With the emergence of Health Insurance Exchanges (HIE) that allow customers to shop for their healthcare payer, it only gets tougher for the insurance industry against heightened competition.

Though many payers have latched on to mobility solutions, it’s more of a “me too” bid. Predictably, the solutions have failed to gain traction with customers owing to unfriendly user interfaces, poor user experience, low performance or lack of relevance. What’s needed is an enterprise mobility plan that’s guided by a strong mobile strategy.

Enterprise mobility solutions have the proven potential to create operational efficiencies within payer organizations, drive solution adoption across users for higher satisfaction and customer delight, enhance patient provider communication, save money, and support innovative sales and marketing approaches. Let’s find out how.

Achieving operational efficiency

Enterprise mobility solutions can enhance operational workflows by enabling employees to work on the go. This results in faster claim processing, authentication checks, and risk assessments. Personnel can quickly pull up a consumer’s health plan on their iPad or other mobile device, verify virtual ID cards, view claim history and upload information to a patient’s claim record in real time. The approval cycle can be significantly shortened.

Mobility solutions can offer cost-effective, easy-to-use alternatives to reduce the high administrative load of manual claim processing. According to a HealthEdge survey, payers have to manually adjudicate 40 percent or more of their claims because of obsolete technology systems. Mobile solutions can play a critical role in minimizing the effort, cost and time utilized here.

Mobile access to critical information can enable decision makers in the organization in taking informed timely decisions that support growth and profitability.

Driving customer satisfaction

Mobility solutions are helping consumers manage their payer-related information through multiple channels. Most of these solutions are coming from third party software developers that target employers who offer these solutions to their employees to reduce “out of network” insurance costs. A healthcare payer solution can help consumers:

  • view and manage their health plan (co-pays, deductibles, benefits, etc.)
  • file and track claims (current and past)
  • manage or view their health savings account
  • find nearest doctors, dentists or pharmacies in the insurer’s network
  • compare services (doctor fees, prescription drug costs, etc.) between physicians or pharmacies
  • access physician directories
  • schedule appointments
  • view electronic ID cards
  • view laboratory test results
  • receive health check reminders
  • get turn by turn directions to the nearest medical center/doctor in emergency situations
  • compare health plan benefits across multiple payers

The healthcare app may also offer value-added services like wellness tips, symptom checkers (for common ailments), and even access to EHRs with the required security and compliance checks in place. Field executives and customer facing personnel can access updated claim data and patient’s health plan on mobile devices to provide meaningful information to customers at the point of contact.

Saving resources, time and money

Manual paper processing of claims cost insurance companies as much as $9 per claim versus 0.80 cents if processed electronically. This percent will continue rising unless quick technology changes are implemented in payer establishments. Custom designed mobility solutions can help payers mitigate this problem to reduce resource wastage and maximize ROI. Anytime, anywhere access to centralized information access will also help payers streamline patient provider communication and contribute to better healthcare.

Enabling sales and marketing

Instant access to prospect data, purchase history, behavioral data, and big data analytics on mobile devices can give sales and marketing personnel an edge. They can make quick changes to sales collateral in real time to make the pitch more relevant to customers, increasing the chances of closing a deal. Advanced mobility solutions can help payers engage customers on social and mobile networks, using snail mail and traditional marketing methods only in special cases.

The earlier mentioned Healthedge survey reveals high interest among payers towards Accountable Care Organization (ACO) participation, pay-for-performance initiatives, and leveraging of value-based benefits (VBB). However, at least 41 percent of this group state that they do not have access to supporting technology. Enterprise mobility solutions are the low cost option that can help payers achieve these objectives and improve the delivery of healthcare.

Source by Ranjani Rao


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