Healthcare Transactions: Simple? . . .not yet

By Mary McKee,

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The face of healthcare is changing and what’s becoming more and more apparent is that the supporting system, i.e. the technology, the inner workings, and the process of transferring information, desperately needs to be updated. Everything in this industry, from medical claims to enrollment changes that come with life events, goes through a process, which leads to multiple subsequent processes. Many of these have not been updated in decades.

With trillions of dollars spent on healthcare each year, why is the technology still so outdated? Information is easily accessible, and can be in front of anyone in milliseconds, rather than days or weeks. Yet, in healthcare, it can take that long or longer for information to get from employers or private marketplaces to healthcare carriers.

While you might think healthcare enrollment or claims submission is - or should be - a simple process, it’s not. It’s still standard for brokers or benefit administrators to submit hand-written enrollment forms for new employees via fax - or even mail. If these forms are, by some miracle, submitted electronically, they’re more than likely being funneled through clearinghouses that use large workforces to manually route, encrypt and send that information via antiquated processes such as FTP (file transfer protocol) or even email. Think about that next time you’re waiting months for a claim to be paid.

The volume of information is high, and there is so much manual labor involved that mistakes often happen. If you follow the news, it’s hard to for a year to pass without an open enrollment fiasco. Last year, for instance, thousands of people lost their healthcare coverage due to inadequate software solutions with Healthcare.gov or on private exchanges. Such mistakes can cause HIPAA violations, overwhelming slowness, and lost coverage - all of which reflect the ineffectiveness of obsolete technology.

A few major players, crippled by miles of red tape and bureaucratic systems, dominate healthcare, and are slow, resistant, and often unable to change. Saturday Night Fever may have been a great film back in the 1970s, but for our healthcare technology and processes to remain rooted in that era, is not sustainable.

Like so many other industries, healthcare is moving away from large, lumbering companies. Smaller more agile startups are using technology to push their way toward change. The healthcare industry is experiencing a drastic reformation and, like it or not, the future of their IT will be a big part of the change.

In our next post, we will be taking a deeper look into how things can and will be better, and what PokitDok is doing to lead the way. In the meantime, visit our website.

About Mary McKee

Mary is a motivated and intuitive EDI analyst with years of experience in the healthcare software industry.

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The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.

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