By Srini Venkat-Oracle on Jan 08, 2015
With healthcare costs rising annually over last decade, health reform is at the forefront of many developed and emerging market countries. In many developing nations, the focus of reform is around business models that have more involvement from private sector, while the focus of the reform in the United States is on business models that incent providers to cut costs while improving quality.
However health reform is in its infancy globally, and there is constant change expected over next several years as governments experiment with various business models. Under those circumstances, there is need for a new genre of technology options to cater to the health system of the future. Current inflexible platforms, and even the newer flexible platforms that require health plans to rip-and-replace entire core operational systems, aren’t going to work for emerging health plan needs. Health insurers need to consider “progressive transformation” approach where there is a phased approach to overall end-to-end core systems transformation. Additionally, insures need to look at options that provide value-based payment support and that work in parallel with their current core processing systems.
Oracle Health Insurance (OHI) business unit within Oracle is dedicated to address the needs of the global health insurance market. The OHI Claims solution was first introduced in 1994 in the Netherlands to cater to the needs of the Dutch market. Today, over 50% of the health insurers in Netherlands run their core operations on Oracle Health Insurance solutions, with many achieving over 98% auto adjudication on claims processing. Furthermore, OHI applications have now been successfully deployed in the United States and other international markets.
The OHI team has spent the last couple of years on developing a technology platform for the newer and emerging health insurance business models. As a team, we are working with governmental institutions and private companies to understand and help these organizations with their transformation projects. Given our origin in Netherlands, we routinely host health officials and delegations from the emerging market countries considering health transformation to study the Dutch system.
Based on those leanings, we are starting blog series to explore different aspects of the health reform as it impacts health insurance organizations. We will present business transformation imperatives one at a time and explore technology options to support this. We encourage you to start by downloading our new white paper Building the Healthcare System of the Future. It lays the groundwork for some of the topics we’ll be discussing in the blog series, such as:
- Driving Transparency with Benefit Adjudication
- End of Fee for Service? Gaining Popularity of Shared Saving Plans
- Engaging with Health Providers in Future
- Real-time Claims Adjudication to Enhance Member and Provider Service
- Technology Platform for Health Insurance Exchanges
- Administering Government Programs in a Cost-effective Way
At the end of the series, we will summarize all of the imperatives ahnd present a holistic platform for the health system of future.
Learn More at Oracle Industry Connect in Washington, DC, March 25-26, 2015
Oracle Industry Connect is a premier conference designed to promote innovation and transformation through open and provocative discussion within the Financial Services and Insurance communities. The event brings together top business and IT executives from leading financial institutions including healthcare payers, insurers and banks. Join your industry peers for in-depth discussions on trends, challenges and opportunities facing healthcare payers and insurers today.
- Register Today for Oracle Industry Connect
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We hope to create a lively discussion throughout this blog series. Please participate with your comments and thoughts as it will enrich the experience as we embark on this transformational journey of Healthcare Reform.
Please check back soon for our next post. In the meantime, you can keep up with Oracle Insurance year-round via social media.