Enterprise automation platforms built on a cognitive computing foundation can help organisations reduce their rising costs
As healthcare insurance and healthcare payer organisations witness major changes in their environment, artificial intelligence with cognitive computing abilities holds significant promise for the industry. There are three important challenges for change management initiatives:
Change across multi-variant dimensions (Examples: consumer trends, payment innovations; and disruptor-induced removal of intermediaries from traditional payer models).
Uncertain nature of change (Example: Future of ACA and scope of CMS bundled payment).
Pace of change manifestation (Example: Last-minute CMS guidelines to operationalising ACA members)
Facing Complexities
Health insurance organisations are facing significant complexities in their core business entities - product (and benefits), network and medical policy. While the passing of the ACA has had an impact, the complexity is also due to consumer-directed health plans or high deductible health plans gaining momentum as a means of involving customers in the cost equation. Payment reconciliation and member engagement aspects were further complicated by health saving accounts.
Initiatives to promote bundled payments (MLR mandates, ACO, PCMH and CMS drives) drove the payers to look for comprehensive payment innovations and led to significant carve-outs and special network arrangements to optimise the costs of specific demographics and high-cost procedures. As medical policies are used as guidelines by payer organisations for adjudging the necessity of specific procedures, any significant progress in medical science can put pressure on clinical staff in the UM area in evaluating cases vis-à-vis medical policies and new research.
Change Management and Implications
هذه القصة مأخوذة من طبعة November 2017 من Healthcare Radius.
ابدأ النسخة التجريبية المجانية من Magzter GOLD لمدة 7 أيام للوصول إلى آلاف القصص المتميزة المنسقة وأكثر من 9,000 مجلة وصحيفة.
بالفعل مشترك ? تسجيل الدخول
هذه القصة مأخوذة من طبعة November 2017 من Healthcare Radius.
ابدأ النسخة التجريبية المجانية من Magzter GOLD لمدة 7 أيام للوصول إلى آلاف القصص المتميزة المنسقة وأكثر من 9,000 مجلة وصحيفة.
بالفعل مشترك? تسجيل الدخول
ENSURE FOOD SAFETY THROUGH PROACTIVE ACTIONS
Explore the critical role of food safety standards in preventing illness and safeguarding health
MODI 3.0: INDUSTRY LEADERS SPEAK
With the NDA securing 291 seats and the BJP 240, the 2024 Lok Sabha election results pose a distinctive challenge for the governing coalition. What implications do these results hold for India's healthcare sector? Read on to find out.
PLI SCHEME: PROGRESS REPORT
With a financial outlay of *15,000 crores and being operational for three years, has India's PLI scheme been proving to be a game changer as anticipated? Read on to find out..
EXPLORE PD HINDUJA HOSPITAL'S INFECTION CONTROL SECRET
PD Hinduja Hospital and Medical Research Centre recently invested in the digitalization of its Infection Prevention and Control (IPC) program by roping in Ibhar Technologies. Healthcare Radius interviewed Dr Camilla Rodrigues, Consultant Microbiologist, and Chairperson - Infection Control Committee, PD Hinduja Hospital, Joy Chakraborty, the hospital COO, and C Bernard, MD, Ibhar Technologies, to understand this development better. Excerpts of the interview:
TACKLING INDIA'S SICKLE CELL ANEMIA CHALLENGE
Sickle cell anemia (SCA), a hereditary red blood cell disorder, poses a serious public health challenge. Examine its prevalence, severity, and the steps that the healthcare sector needs to take.
Fortis Mohali saves patient with robot-assisted kidney surgery
Doctors at Fortis Hospital, Mohali perform complex robot-assisted surgery on a transplanted kidney, saving a 56-year-old cancer patient.
Sakra Hospital performs record surgeries for Karnataka
Sakra World Hospital, Bengaluru sets a record for Karnataka state by performing 425 orthopedic surgeries in May 2024.
Meghalaya honors cancer survivors
Meghalaya celebrates National Cancer Survivors Day, recognizing the strength of cancer survivors and raising awareness about cancer care in the region.
Early brain tumor detection key to better patient outcomes - Expert
Neurosurgeon at RNC Hospitals, Dr Naveen Reddy stresses the importance of early brain tumor detection during a seminar on World Brain Tumor Day.
Immunization schedule for women released
FOGSI unveils detailed immunization schedule for adult women and new mothers, providing essential vaccines and recommended frequency.