Skip to content
Vyhledejte informace o produktech a řešeních InterSystems, kariérních příležitostech a dalších.

How Healthcare Payers Can Strategically Leverage Regulatory Mandates for Enterprise Innovation

IDC Analyst Brief

For healthcare payers, a strategically planned implementation journey for regulatory mandates encourages data flexibility, democratizes workflow, and enables innovation across the enterprise. Continue building your enterprise infrastructure, tempering the zeal to go at mandates one-at-a-time.

What's Important

  • Establish an overall vision for data and workflow ecosystems, then modularly implement sections of the architecture using mandates to help sequence investments.
  • Resist the temptation to “check the box” with minimally compliant implementations of mandated requirements.
  • Allow requirements around mandates to be a driver to innovation instead of a necessary evil to be dispatched.

Key Takeaway

  • Standardization of data formats, consumerization, payer-provider organizational shifts, and whole-person approaches to healthcare require optimizing merged data as part of your integrated, less tactical mandate journey.

Introduction

Healthcare payers have implemented technology solutions to address state and federal mandates for over a decade. A timeline of mandated requirements during this period includes notable developments such as:

  • 2010: Medical loss ratio
  • 2011-17: Affordable Care Act
  • 2017-24: Value-based reimbursement
  • 2019-22: COVID-19-based telehealth regulations
  • 2017-22: Directory accuracy and network adequacy
  • 2020-24: API-based Interoperability
  • 2021-24: Price transparency
  • 2023-27: Interoperability and prior authorizations

Without a doubt, more mandates are forthcoming.
At the same time, the payer business model is in flux. Alignment and collaboration with healthcare providers, other payers, and nontraditional organizations is flourishing as payers attempt to address the cost of care.

Even as vendors demonstrate their ability to deliver enterprise-grade solutions that address both current and future mandated requirements, many payers continue to take a one-year, tactical approach for each project. To ensure operational excellence for members, providers, and internal constituents, payers instead need to evaluate individual mandates in the context of an overall vision.

Deploying technology to address mandates is not a linear destination but a multi-faceted journey. This journey takes into consideration costs and compliance, but more importantly, it can lead to the emergence of an ecosystem that encompasses comprehensively managed data and workflow enhancement for competitive advantage.

Další Zdroje, Které By Se Vám Mohly Líbit

zář 18, 2024
Zjistěte, co je to relační databáze, jaké jsou její klíčové vlastnosti a proč je pro vaši firmu klíčová. Přečtěte si o jejích výhodách, oblíbených systémech a srovnání s jinými databázemi
zář 18, 2024
Datová struktura modernizuje správu dat a poskytuje zjednodušený přístup, transformaci a harmonizaci dat pro různé podnikové aplikace.
zář 09, 2024
Spotlight by Bloor
Data fabric is a more flexible data architecture that can work without building yet more data silos and instead synamically access data in situ in operational source systems.
zář 09, 2024
Bloor Market Update
A look at the current state of the data fabric market by Bloor Research
zář 06, 2024
Bloor Research
A Bloor Gold Mutable Award 2024 By Andy Hayler – Practice Leader, Data as an Asset InterSystems and the Data FabricWhy Should You Care?
srp 09, 2024
A CHIME Thought Leadership Roundtable
At a CHiME Roundtable, executives from leading HCOs came together to discuss how artificial intelligence revolutionize clinical care.
čvc 26, 2024
Harris Associates
Implementací InterSystems Smart Data Fabric společnost Harris Associates odbourává datová sila a zkracuje dobu potřebnou k přijímání informovaných obchodních rozhodnutí.
čvc 26, 2024
Forrester Research
Společnost InterSystems je uznávána jako Strong Performer, protože poskytuje "komplexní datovou strukturu pro podporu jakéhokoli případu použití ve velkém měřítku".
čvc 22, 2024
Technology Guide
Enabling integrators and developers to deliver highly customized intelligent supply chain applications
čvc 11, 2024
Eleven common questions and answers
Today more than ever before, organizations are striving to gain a competitive edge, deliver more value to customers, reduce risk, and respond more quickly to the needs of the business. To achieve these goals, organizations need easy access to a single view of accurate, consistent, and trusted data – and all in real time. However, growing volumes and complexities of data make this difficult to achieve in practice. As data grows, so does the prevalence of data silos, making integrating and leveraging data from internal and external data sources a challenge.

Udělejte další krok

Rádi si s vámi promluvíme. Vyplňte některé údaje a my vás budeme kontaktovat.
*Povinná pole
Highlighted fields are required
*Povinná pole
Highlighted fields are required
** Výběrem možnosti ano dáváte souhlas k tomu, abyste byli kontaktováni pro novinky, aktualizace a další marketingové účely týkající se stávajících a budoucích produktů a událostí společnosti InterSystems. Kromě toho souhlasíte s tím, aby byly vaše kontaktní údaje zadávány do našeho řešení CRM, které je hostováno ve Spojených státech, ale je udržováno v souladu s platnými zákony o ochraně osobních údajů.