By Feri Clayton
Director Imaging and Capture Solutions, IBM
The Affordable Care Act has brought a dramatically new landscape to the business of health insurance. The elimination of pre-existing conditions, the expansion of Medicare into rural areas, and broader coverage for both young adults and early retirees are just some of the major impacts. The demand for increased transparency and tighter medical loss ratio requirements are driving important operational changes. Requirements have become increasingly demanding as plan structures evolve and insurers initiate new systems, products and processes to appropriately comply with the new legislative changes. The pressure for cost containment is intense as organizations react, often rapidly and without a great deal of clarity, to the evolving demands in the market place.
The industry is at a tipping point and healthcare organizations have responded to the implications in two ways: with great efficiency or with great inefficiency. One reason organizations struggle is due to the current state of their Enterprise Content Management systems. Despite technological advancements, many companies continue to use legacy systems, siloed within IT departments, and built upon a mishmash of technologies. This makes it difficult to appropriately respond to the new legislative, business requirements and the corresponding shifts in the market.
Putting Paper in the Past
Healthcare reform continues to push the industry toward an increasingly paperless environment. This will result in an increase in the number of digital documents that need to be captured and managed, as well as the need for more robust and efficient systems to support the increased complexity and variation in content. Indeed, according to the law, the goal for all financial and administrative transactions is that they “permit no constraints for electronic transactions and require minimal augmentation by paper transactions or clarification by further communications.” In many cases, insurers and providers will be compelled to maintain equivalent electronic and paper versions of the same document. The law requires that paper versions of standardized transactions “comply with the same standards as to data content such that a fully compliant, equivalent electronic transaction can be populated from the data from a paper version.”
New Generation ECM
The good news for health insurers and providers is that a new breed of intelligent capture and document management tools bring a new level of agility to the content management process. New generation of ECM software solutions integrate with existing legacy systems while providing advanced capabilities that help lower cost, accelerate decision-making, reduce risk, and comply with regulations. Examples of such ECM solutions are intelligent document imaging, mobile data capture, case management and advanced analytics. That is what IBM ECM provides – all built within a single platform. The result is more cost-effective, agile and accurate systems and workflow to so many of our healthcare clients.
One good example of such software is IBM Datacap Medical Claims. This solution enables capture of both paper and electronic CMS-1500 and UB-40 medical claims. It automatically extracts and validates data from these documents helping health insurance payers and third-party administrators eliminate labor-intensive manual processing of claims. Learn more here:
Are you ready to move forward? Look for solutions and partners that provide the right mix of expertise, vision, and advanced capabilities that will allow you to leverage the full potential of new ECM technologies. That is IBM ECM! ibm.com/thatsecm/