A real-time health system is a model for the next generation of healthcare providers and systems from both operational and technological standpoints. If there is operational intelligence surrounding the patient the enterprise can anticipate and respond to quickly changing situations. It is no surprise that payers reimburse varying amounts to providers depending on their contracts; the range of price fluctuation is high. When payer regulations rake place, consumers, payers, providers, employers, consultants, digital health technology enterprises, and academics will have significantly more price data (Cole, 2021). It will become important to quickly bridge multiple provider network management platforms to core administrative systems.
Providers can market their billing support services for members and dynamically offer members financial incentives to compare care options. Interoperability and artificial intelligence (AI) technologies can help successful payers make a member’s care journey not just quicker but also significantly less complex (Cole, 2021). For example, command center software platforms use systems engineering, predictive analytics, and problem-solving to control patient flow in and out of the health system while maintaining clinical quality, safety, and patient experience. Systems like EPIC, Cerner, and Allscripts are pushing automation in business operations that depend on repetitive tasks, such as supply chain, revenue cycle, and customer service. As per AHA projections, U.S. hospitals will exceed $320 billion in losses as an impact of Covid-19 (Cole, 2021). Payer plans can benefit from generating plans that target groups based on employment and income factors. Having a real-time payment system can reduce future losses.
Payers can consolidate all their member health care spending into one tool that reconciles provider bills automatically. With the use of AI, clinical data collected from providers can be analyzed and used for optimizing user cases. Companies like Amazon and Apple are beginning to launch clinical data services. Amazon’s comprehend medical serves healthcare organizations it uses natural language processing to extract and standardize features from unstructured clinical data (Bishop et al., 2019). The API allows providers and payers to access and integrate the data. To meet the increasing market demands for robust solutions, IT companies have an opportunity to establish a collaborative discipline across providers and payers.
Cole , B. (2021, October 15). Quick Answer: How Will Consumer Price Transparency Make U.S. Healthcare Payers More Composable? Gartner .
Cole, B., 2021. Quick Answer: How Will Leading Healthcare Payer CIOs Deploy Transformative Technologies In a New Business Model?. Gartner.
Bishop, M., Runyon , B., Cribbs, J., Cole, B., & Dev, S. (2019, October 4). Healthcare collaboration point for cios: Clinical Data Integration. Gartner.