ICD-10 is a topic rarely discussed in the virtual hallways of the health insurance industry. News is floated out into the ether, but not much chatter results. Providers and vendors discuss the topic ad nauseam, but payers are mostly mum when it comes to the impending, and I suspect ominous, new technology.
And so it was when the Centers for Medicare & Medicaid Services officially delayed the timeline for all healthcare organizations to convert to ICD-10. Payers and providers now have until Oct. 1, 2014, to start using the new coding system. But not much discussion of the matter ensued.
I hate to burst any bubbles, but if payers aren't already on the path toward the October end goal for ICD-10, they have a lot of work to do. "If you haven't already started your ICD-10 remediation program, you are going to fall behind quickly," Ray Desrochers, executive vice president at HealthEdge, told FierceHealthPayer. "And there will unlikely be further delays to take advantage of."
What's more, payers face millions of dollars in ICD-10 transformation costs and hundreds or even thousands of employee hours of effort. This is particularly true for payers with multiple non-integrated systems using older technology, such as core claims, secondary systems and interfaces to partner networks, Desrochers added.
So that's the bad news.
But the good news is that by implementing the ICD-10 coding system, payers can use it to support other healthcare models, including accountable care organizations and value-based health plans. "Too many payer organizations look at compliance with ICD-10 as an objective to be met in and of itself," Desrochers said. Instead, they should see ICD-10 as an "impetus to deploy modern technology" that will help companies adapt in the future.
I wonder if this tunnel-vision view of ICD-10 is what keeps payers from chatting and, more importantly, taking action on the new and updated code.
"The use of antiquated IT infrastructures has been holding payers back from adopting new healthcare business models for decades," Desrochers said, pointing to outdated core platforms, significant manual processing and satellite systems as primary roadblocks. In fact, a recent HealthEdge survey found that 63 percent of respondents rely on technology more than 10 years old, while 39 percent use IT that's more than 15 years old.
Such outmoded IT systems prevent payers from participating in the varied business opportunities quickly gaining traction in the market. Without the right technology, including ICD-10, payers can't adequately join ACOs, design value-based health plans, enhance customer service or ensure interoperability, Desrochers said.
So what's a health insurer to do? Desrochers suggested they find ways to "leverage modern technology platforms to meet their 21st century business goals because business as usual is no longer a viable option." The first step to that seemingly tall order is determining how they want to compete and be viewed in the market by asking themselves questions like these:
- Will they be leveraging one or more new healthcare business models?
- Are they looking to expand into new markets or take advantage of unique opportunities?
- Will they be prepared to handle Medicaid market increases and individual market growth?
- Is there a focus on leadership in areas like member and provider satisfaction?
- Are they going to be delivering other new products or offerings that will allow them to differentiate from the competition?
Next, payers should evaluate the capabilities of their current systems, including satellite systems, custom databases and stand-alone reporting solutions. Once this step is complete, they can categorize all manual processes and compare existing capabilities with new business initiatives they plan to implement and create a corporate technology plan, Desrochers said.
The hard part of actually implementing the IT systems comes next and although it's a taxing process for the entire organization, payers can take comfort in knowing that leveraging a modern IT infrastructure will enable them to "quickly take on any type of new business, respond in real-time to market changes and customer needs, immediately address new and emerging regulatory standards like ICD-10 and ICD-11 and move faster than the competition," Desrochers said. Now that's something we should all be talking about. - Dina (@HealthPayer)