Sourcing Advisory

Driving Healthcare Efficiency through Transformational Sourcing

George Clark & Rajarshi Chatterjee

The signing of the Patient Protection and Affordable Care Act (ACA) into law in 2010 along with subsequent provisions and amendments taking into effect from 2011 to 2013 marked a complete transformation of the U.S healthcare eco-system. The ACA represents a landmark moment that has affected the entire healthcare community, including citizens, businesses, healthcare payers & insurance companies and healthcare providers (hospitals, clinics, and physicians). As employees seek better and more affordable options, healthcare payers and providers have the mandate to drive down costs, expand coverage, as well as innovate to improve the quality of healthcare services. Healthcare payers and providers need to plan, configure, and implement the ACA’s new regulations into an integrated delivery model.

Redefining the role of Healthcare IT

To adapt quickly to this huge change in the US healthcare ecosystem, both payers and providers have turned to healthcare information systems more than ever before. Healthcare IT has the potential to enable such a dramatic transformation by improving the efficiency, cost-effectiveness, quality, and safety of medical care delivery. Some of the key areas where Healthcare IT is playing a major role in this transformation are:

Provide Access to Information: Electronic access to patient health Information makes a substantial impact on medical quality and safety by reducing treatment errors that result from gaps in knowledge or the failure to synthesize and apply that knowledge in clinical practice.

Improve Efficiency: Use of IT systems improves the efficiency and financial position of the clinical practice through computerized scheduling, productivity tracking, and automating reimbursement processes.

Integrate Delivery: The widespread adoption of IT systems creates system connectivity and information exchange among all the stakeholders in the health ecosystem including payers and  providers regionally and nationally.

Key IT Sourcing Drivers for Healthcare Providers

The primary issues facing the healthcare provider industry today are falling productivity, lower profits, and the growing need for integration with the payer model. Such business challenges at functional levels are driving greater adoption of IT and BPO Sourcing in recent years. Health care providers and distributors account for approximately 80 percent of all health care spending. Post the implementation of the Affordable Care Act; healthcare providers face three specific challenges:

Regulatory compliance – 2014 is a turning point for U.S. providers, framed by long-anticipated regulatory requirements including the beginning of the meaningful use stage 2 reporting period on January 1, 2014, and the planned implementation of ICD-10 diagnosis coding on October 1, 2014.

Optimizing business models and processes to drive value – With ever-increasing advances in information technology and medical discovery along with public demand for transparency into delivery safety, quality, and cost, providers must renovate their business models and processes to achieve both enterprise-wide conformity and agility.

Ensuring Data Security and Privacy – In the post EHR era, providers need to understand and ensure patient medical records privacy and provide secure exchange of such information in an integrated care delivery model.