Using technology to automate business processes is a good thing that enhances operational efficiency and drive cost savings, right? Not always. Today’s health-care industry offers a counter-intuitive case in point.
As the Affordable Care Act continues to transform the health-care market, a growing number of health-care insurers are finding that maintaining and upgrading automated claims processing applications is becoming prohibitively expensive. In fact, decreasing automation and increasing investment in personnel can in many cases produce a more cost-efficient outcome.
In recent years, health-care payers have poured significant resources into developing software applications that automate the process of reviewing and processing claims for reimbursement of health-care costs – in some cases achieving auto-adjudication rates approaching 90%. At the time, this approach made sense, and these highly customized legacy systems were proven to be effective in relatively static environments.
Today, of course, it’s a different ballgame: health-care reform is driving fundamental and ongoing changes in regulatory and data reporting requirements. This means the myriad applications involved in auto-adjudication require constant upgrades, which not only drives costs but piles layer upon layer of additional complexity on to already highly customized and heavily engineered systems.
Read the full report here.
Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.