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June 18, 2019

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Health Insurance Companies: How to Improve Administrative Workflow

Health insurance companies will greatly benefit by improving their administrative workflows. These companies have a number of routine tasks that are part of their business like processing claims, making payments, improving sales, keeping up with benefit and rate changes, and providing quotes and other information to customers. As the company grows, each of these tasks grow in complexity and volume. Also, health insurance companies deal with diverse entities like regulatory agencies, customers, healthcare professionals, pharmacies and so on, and introducing technology to deal with this complexity is the only way of the future.

Currently, adoption of technology in the health insurance market has been limited. Many health insurance policies are outdated and unnecessarily complex and need to be revised. They are unable to meet the needs of many customers. Medical records are not universally accessible with poor referral management to specialists, avoidable hospital readmissions and longer stays in hospitals than necessary.

As a result, the growth curves in the health insurance market have been moving downwards, declining by 6-9% in the recent years. But some health insurance companies have begun to adopt current technology in their processes, and have begun to leverage the power of the latest technology to breathe life into the lagging market. Using technology driven processes and lean workflows, they are able to provide experiences customized for customers, reducing expensive claims and costs. This will increase efficiency and improve productivity.

Clear process models will need to be developed. Bottleneck areas can be identified, and eliminated. Many legacy systems, guidelines and processes exist which will have to be upgraded. Thresholds will need to be developed and set for processing times in different areas like claims, premiums, and so on.

All of these updates and changes will require technology upgrades. Overhauling the way health insurance companies do business is a very complex task, with a variety of interdependencies and external factors. Health Information Technology (HIT) and electronic health records (EHRs) form the cornerstone to these upgrades. Some of the most relevant HIT upgrades in their administrative workflow will involve Big Data Analytics, Artificial Intelligence, and Cloud data storage.

The administrative workflows of health insurance companies are already undergoing revolutionary changes, and these will continue. The relationship between providers, insurance companies and patients will grow tighter with more information being shared and this information being available with decreased access time. There will be comprehensive databases of patient records with complete medical histories accessible from different locations. Insurance companies will provide better policies customized to groups of patients, and the claim processing time will be significantly decreased. Patients will have better access to health insurance information through a variety of sources.