The Healthcare Ecosystem – IT initiatives at Payers and Providers

Provider & PayerI enjoy understanding the different aspects of the healthcare IT ecosystem and working to make collaboration in healthcare a much more transparent process. I’ve been fortunate that for the most part over the last couple of years, I have worked with very collaborative people. In a sense, I’ve seen the positive aspects of great collaboration.

During a meeting earlier today, I was able to get insight into some of the priorities at the other side of the healthcare ecosystem; the payer side of the world. While some of the regulatory priorities are the same, it sounded like that there was a much better maturity in terms of their ability to govern their initiatives and pivot where required. One thing though is somewhat similar. ICD-10 project is suspended and possibly postponed. Concern over whether CMS will do away with ICD-10 altogether is somewhat high. That isn’t going away as it has been delayed twice already and all of healthcare is not happy about their hard work over the last couple of years not bearing fruit. Thoughts are that ICD-10 projects would be suspended until the end of the year by payers, (generally much better at getting those initiatives accomplished) or the beginning of next year and integrated testing between payers and providers may resume, barring any further delay by Washington. XP to Win7 migrations still seem to be going on as are optimization initiatives. Security will continue to dominate and the movement to utilize the cloud needs to get stronger as each day passes. If we can do banking transactions online and file our taxes online, why can’t we securely get our healthcare initiatives executed through the cloud.

ERP though (yes I did say ERP, a voice from the past comes back) is still on the minds of Payers and they will need to think about the alternatives there in order to lower the costs of management as they have cost pressures due to the 80/20 rule and the 85/15 rule that I have spoken about in the past and will discuss in a future post again. Retaining members, being able to derive analytics from their data and be able to accurately leverage it for member benefit was a nice thing I heard today.

There still seems to be quite a bit of ambiguity as to the healthcare insurance marketplace, which I know has been a hotly contested and politicized issue (so I won’t discuss it further here).

Oh, a free plug for my favorite HIMSS Chapter. Don’t forget to attend the CSO HIMSS conference this Thursday (yes Thursday) in Wilmington at the Roberts Center. See http://www.csohimss.org for registration and the agenda. See you there.

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