5 trends influencing carriers

Carriers have a lot of work to do in advance of the Patient Protection and Affordable Care Act's major provisions taking effect next year.

The law will drive significant change throughout the health insurance industry, according to SunGard, a software and IT services provider. And carriers need to be ready to achieve growth in the midst of all the change.

“Health payers’ new business strategies are driving the need to streamline business processes and react quickly to capture new revenue streams,” said Paul Tiede, executive vice president of SunGard’s insurance business.

Tiede pointed out five key trends that will influence carriers' decisions this year. >>>

profit

1. “Increasing pressure on profit margins and manual processes, which will drive the need to gain efficiencies in financial accounting, investment management and claims processing.”

revenue

2. “Carriers are driving industry consolidation in order to diversify revenue sources and achieve agile growth in new markets, such as increasing their Medicaid business through acquisition of niche players, focusing on the individual consumer market, and expanding into more states.”

medicaid

3. “More states are shifting the management of their Medicaid plans to private sector managed care plans, enabling states to reduce risk and cost while requiring health plans to increase agility in business and technology frameworks to support growth.”

Photo: Larry Walker shows his support for Medicaid extension outside the Ohio Statehouse during a rally urging state lawmakers to extend Medicaid coverage under the federal health care law. AP Photo/Jay LaPrete 

4. “The expansion of accountable care organizations and health exchanges will facilitate innovation by connecting providers, facilities and payers to form an electronic, patient-focused model, simplifying claims processing, and establishing incentives for healthy patient behavior.”

5. “As carriers change their business models, they will look to operate smarter through vendor-provided technology, business process management, and managed services offerings.”

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