Conquering Healthcare Reform and Rating Complexity with a Simple, Single System
By Calvin Glenn on Jun 06, 2013
We all know about the Patient Protection and Affordable Care Act that was upheld by the US Supreme Court in 2012. Now, how do we respond and react to embrace this legislation while also providing quality service to our customers and maintaining an edge over our competition? While states debate whether to expand Medicaid, launch health insurance exchanges, or both, payers have less than 18 months to plan their strategies, change their infrastructure and launch new products to capture market share. Payers must now learn to interface directly with end users. And they must learn the nuances of local markets. Flexible IT systems that enable unprecedented business agility will be critical to their success.
In executing on the individual mandate, payers need to take a hard look at their underlying rating infrastructure.
- Is it flexible enough to accommodate new customers and roll out new products quickly?
- Are the rating systems configurable so they do not require custom coding when the business needs change?
Payers should consider an enterprise stand-alone rating engine – used primarily to externalize the rates, rules, and logic associated with rating from the policy administration system – to increase speed to market and reduce costs. Older policy administration systems embed rating logic within the code, making modifications complex and dependent on IT support. Payers who run multiple policy administration systems, spreadsheets and other rating engines, end up with data redundancy, inaccuracies, and duplication of efforts as rating changes get implemented across multiple solutions. With a single rating engine, rates can be built once and distributed to any application, resulting in better speed to market, improved productivity, and greater flexibility.
An enterprise rating system should support all market segments from individual to small and large group. It also should have a user interface that is simple enough for the business user to create, test and deploy complex rating, rules and underwriting logic without programming expertise, speeding time to market for rate changes and new products. Key components of a good enterprise rating system include:
- Rules management
- Testing and Modeling
Oracle Insurance Insbridge Rating and Underwriting can help carriers overcome all of the issues they’re facing as they prepare to comply with the Affordable Health Care Act. Oracle Insurance Insbridge is a simple, fast and accurate rating system designed for business users. Companies can augment their legacy systems and centralize rating to a single system that allows for regulatory compliance by holding one version of the rates and eliminating anomalies between quoting engines and policy administration. Oracle Insbridge is also flexible and scalable to grow with your business through proven run-time and design-time integrations.
We’re just wrapping up a very successful week at IASA where we’ve had a chance to talk with carriers and clients and look forward to next week when we’ll be in Las Vegas at AHIP’s Annual National Institute. Please stop by booth #560 at the AHIP Institute and June Exchange 2013 conferences to discuss the latest trends in the market and how Oracle Insurance can provide you with insights for overcoming your biggest Health Care Reform challenges.
JOIN US at the June AHIP Exchange Breakfast Session: Wednesday, June 12th – 7:45a.m – 8:45a.m.
Strategies for Success: Driving Business Transformation in the Growing Health Insurance Exchange Market
Janice W. Young, Program Director, Payer IT Strategies, IDC Health Insights
David Bonham, Master Principal Pre-Sales Consultant, Oracle Health Insurance
Health Insurance Exchanges are considered to be key catalysts for change. This session will offer insight into opportunities for health insurers to advance transformational strategies in support of more efficient and patient-centered business operations, executing on the individual mandate. Attendees will learn how to achieve integration within a Health Insurance Exchange – enabling a business focus on the growing individual market. Discussion will cover steps and processes for successfully establishing and implementing enrollment systems, quote to card activities, program pricing, claims billing, automated claims processing, and new customer service tools. Additionally, speakers will cover specific tools and enabling technologies for Health Insurers to develop and deploy alternative provider and member reimbursement models to effectively support their relationships with Accountable Care Organizations (ACOs
We look forward to seeing you next week at AHIP!
- Strategy Brief: Executing on the Individual Mandate: Opportunities and Challenges for Healthcare Payers
- Strategy Brief: Enterprise Rating Agility Improves Payer Response to Healthcare Reform
- Podcast: Technology Implications of Healthcare Reform
Don’t forget to keep up with us year-round: