A survey conducted to understand the healthcare payer market size, shares, trends, and analysis stated that the global payer healthcare market is forecast to reach $111.9 billion by 2030.¹
As we start rolling up our sleeves to get over quarter two (Q2), several technologies are continuing to transform healthcare soon. Payers must be coerced to adapt with many abatements coming sooner than later.
So, let us walk you through the trends for health care payers in 2022.
Healthcare payers are redefining their role to deliver higher value-based care to members as many are transitioning from a fee-for-service model to a value-based care model.
Who are payers in the health care industry and what do they do?
Payers in the health care industry include Integrated Delivery Networks (IDNs), Managed Care Organizations (MCO), Accountable Care Organizations (ACO), and Independent Practice Associations (IPA) who set service rates, collect payments, process claims, and pay provider claims.
Private payers are insurance companies and public payers are federal or state governments. These are the two major types of Payers. An insurance company is the most common type of payer, they are responsible for processing patient eligibility, enrolment, claims, and premium payment.
What are the latest trends for payers in the health care sector in 2022?
1. Adopt a modern chart review risk adjustment tool
Like most healthcare transactions, consent for patients is shifting from paper to electronic. Automation is the latest buzzword and it is rapidly spurring in the health care industry. Payers must adapt and implement processes and data exchange techniques that enhance members or participant’s in value-based care programs.
As the healthcare industry majorly experiences hardship due to unstructured data. Payers also will need to manage audit trails and version controls now that patients will be addressing many consents from their end. Therefore, a three-click chart review risk adjustment model can be an ideal solution for value-based care to mitigate data inaccuracy and enhance productivity.
2. Real-time dashboard for tracking medical coder’s productivity
Medical coding companies who work with multiple medical payers for their multiple patient chart review needs create a leap of overheads, paperwork, and administrative hustles.
NLP-powered AI-Enabled risk adjustment analytics solution will offer the desired change, reduce costs and improve the medical coder’s productivity and accuracy. AI solutions are helping payers in the health care industry streamline the processes and further free up human resources. Implementing such efficiencies will result in bottom-line savings.
The irrefutable goal of this digital shift is to break down the barriers and allow information to accredit a refined and enhanced healthcare framework. Payers in healthcare have recognized the importance of advanced technology for better healthcare interoperability, data accessibility, and transparency in healthcare delivery services.
3. Auto-code suggestion
RAAPID uses NLP Powered AI-Enabled Risk adjustment solutions to optimize the risk adjustment process. It can be configured to automatically optimize HCC Risk Adjustment Coding & Chart Retrieval Solutions which do not support unreported diagnosis codes.
AI-Enabled Risk adjustment solution maximizes the productivity of the risk adjustment process by prioritizing charts with precision to support unstructured diagnosis codes by identifying the retrieval modality and predicting disease conditions possibly supported in the chart for coder review.
Payers in the health care industry can stay ahead of the curve by adhering to the above three main trends in 2022.
A comprehensive risk management solution will allow your medical coding company to automate, scale, and improve chart review workflow for your medical coders.