Real Time Adjudication: Bringing Healthcare into the 21st Century
We are in the midst of a digital revolution. Over the past few years, the terms “disruptive”, “innovative” and “(fill in the blank) – tech” have appeared in virtually all media and business conferences throughout the world. We get a daily dose of news about how technology will transform the way we do business and the way we consume goods and services. We hear how much better life in general will be in the very near future.
When it comes to healthcare, we see Medicare moving to an interoperable environment where a connected circuit of providers and payers will make the delivery of appropriate treatment more efficient. Today, workers’ compensation medical treatment initiatives are more focused on the use of medical treatment guidelines and prescription drug formularies even though technological advances already exist to enhance the overall occupational medicine environment. Policymakers, health care providers, and employers of all types also continue to develop strategies to curb the abuse of opioids – another area where new technologies can provide invaluable benefits.
Today, workers’ compensation medical treatment initiatives are more focused on the use of medical treatment guidelines and prescription drug formularies even though technological advances already exist to enhance the overall occupational medicine environment.
The need to adapt to new healthcare technology is not just to make delivery of care faster and less expensive, it is to make it better as well. The successful delivery of better health care in the 21st century is measured in many ways – including reducing costs to individuals, employers, and providers of medical care. But it is also measured by better clinical outcomes, higher patient satisfaction, and more successful return to work results for injured workers.
The need to adapt to new healthcare technology is not just to make delivery of care faster and less expensive, it is to make it better as well.
In order to fulfill the promise of today’s technological advances in health care delivery, the provider-payer environment must move away from paper. This is an obvious but monumental task. The road that begins with a request for authorization winds its way through the utilization review process and, along the way, may involve specialists, pharmacists, or pharmacy benefit managers, and eventually ends with payment for approved services. That journey should be on one circuit in which everyone is connected in real time, not on a road that is full of potholes, speed bumps, and detours.
Technology – if designed and deployed properly – repairs the inefficient infrastructure of health care delivery. That repair is beginning in many different environments, and its transformative effects are inevitable. To be part of this transformation, payers must embrace real-time solutions that focus on the entire request-approval-payment circuit. Otherwise, patients, payers, and providers are left with the deny-delay-dispute status quo that serves no one’s best interests.
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