Technology is Transforming the Insurance Sector

The insurance industry, for a long time, has been driven by traditional business models. It continued its legacy business process and products for quite some time.  But with the intervention of innovative technology, the insurance industry has witnessed positive outcomes.

Advanced technologies and digital platforms are providing new means to measure, control, and track risks. They facilitate effective engagement with customers and enhances business productivity.

These technologies supported by dedicated insurance software are opening the market for new insurance offerings. It has provided an opportunity for traditional insurers to transform and reinvent themselves. Moreover, it has compelled them to respond to new market challenges.

In this article, we will focus on how technology is reshaping the insurance business. Besides, how it is presenting new opportunities and driving factors of change. Read More:

New Availity and Regence white paper details challenges and opportunities for improving the pre-authorization process

Availity, the nation’s largest real-time health information network, and Regence, a family of regional health plans serving members in Oregon, Washington, Idaho and Utah, announced today the results of their collaboration to improve the pre-authorization process through the implementation of new tools that allow for real-time, electronic and automated pre-authorization.

To download a copy of “Adhering to Cost-Effective, Evidence-Based Care Through Improvements to the Pre-Authorization Process,” click here.

The pre-authorization process helps determine coverage of prescribed services or treatments, providing additional oversight to uphold safety, efficacy, quality, and cost-efficiency of care. However, it can be a source of frustration for providers when it causes unnecessary delays of treatment for patients.

Regence and Availity embarked on a pilot program to redesign and improve this process to increase efficiency and reduce providers’ administrative burden. The focus was automating key components throughout the entire pre-authorization process.  Read More: Regence

Blue Cross and Blue Shield of Illinois Offering New Comprehensive Kidney Care Program to Help Improve Member Health

Blue Cross and Blue Shield of Illinois (BCBSIL) is partnering with Somatus on a new program for certain members with Chronic Kidney Disease (CKD) or End Stage Renal Disease (ESRD). The program is the newest BCBSIL value-based care arrangement focused on closing gaps in care by improving care coordination, further preventing or delaying the progression of CKD, better supporting the social needs of these complex members, and ultimately working to improve access, quality and health outcomes and lowering the overall cost of care.

The Somatus Kidney Care Program addresses social determinants of health while providing comprehensive in-person and virtual support for members that includes:

  • Transition services following hospitalization, to help understand changes in medication or home care plans;
  • Diet, lifestyle, and medication management;
  • Access to community resources, including medication assistance programs, transportation and financial support; and,
  • Treatment option education to help members decide the best treatment method. Read More: BCBSIL

Blue Cross Blue Shield of Michigan Partners with Premise Health

Blue Cross Blue Shield of Michigan and Blue Care Network have partnered with Premise Health to bring new solutions to group customers – employer-sponsored health and wellness centers. Based in Brentwood, Tenn., Premise Health is the largest direct health care provider in the nation, connecting its members to high-quality, cost-effective care through physical and digital access models.

The partnership between Blue Cross and Premise Health will provide an integrated experience for both members and customers. Onsite and near-site health and wellness centers have emerged as a priority for employers who wish to provide their employees and their families a convenient way to access health care by removing barriers related to access, time away from work, and cost. Onsite health and wellness centers also provide customers additional predictability and optimization over health care spending, while enabling them to focus on the physical and mental health of their workforce. Read More: MIBlues

Stellar Health Announces Partnership with Elderplan, Inc. to Improve Value-Based Care Delivery Across New York City

Stellar Health (“Stellar”), a leading technology company that offers a web-based point-of-care platform that leverages historical patient information to provide granular, value-based action prompts to the entire primary care team, has expanded their footprint by partnering with Elderplan, Inc. (“Elderplan”). Elderplan, which offers health plans for Medicare and Dual Eligible beneficiaries, along with HomeFirst, one of the original managed long-term care plans in New York, is a member of the not-for-profit MJHS Health System family and has partnered with Stellar to support its network in attaining value-based care (“VBC”) success.

Stellar helps primary care providers achieve VBC goals and rewards practices for the time they spend on value-based actions with real-time incentives. Elderplan has implemented Stellar’s innovative point-of-care platform and real-time incentive model across their provider network, working in close collaboration with independent practice associations (“IPAs”) across New York City. The IPAs using the platform include, Rayn, Excelsior, Bronx United, Proactive Care, Central Queens, Sovereign Phoenix, Starling, and Empire. These organizations play a pivotal role in provider success and have embraced Elderplan’s value-based care commitment. Read More: PRNewsWire

Harvard Pilgrim Health Care and Doctor On Demand Launch SimplyVirtual(SM)

Harvard Pilgrim Health Care today announced the launch of SimplyVirtualSM, a new, innovative model for health care that gives members access to virtual visits with primary care providers (PCPs) and care team support through its existing partner, Doctor On Demand. The new plan will be available to large employers (51+ subscribers) in Connecticut, with a January 1, 2021 effective date. SimplyVirtualSM is the first virtual primary care plan being offered by a health insurance company in Connecticut.

The COVID-19 pandemic has led to an accelerated, increased demand of telehealth and virtual doctor visits. While in-person visits are resuming, patients have a continued interest in this model of health care. From February 2020 to April 2020, Harvard Pilgrim Health Care member use of telehealth services increased by 6,148% in Connecticut alone. The new SimplyVirtualSM plan is an affordable alternative for plan members who value the flexibility that telehealth offers, and are looking for a relationship-centered experience that focuses on shared decision-making between providers and patients. Read More: PrimePublishers

Qualcomm and Merrill Steel Honored by the National Alliance for Healthcare Strategy Innovation

Qualcomm and Merrill Steel were awarded the 2020 Employer/Purchaser Excellence Award by the National Alliance of Healthcare Purchaser Coalitions at its Annual Forum. The Pittsburgh Business Group on Health was recognized with the 2020 Membership Leadership Award and Cigna received the 2020 eValue8™ Innovations Award.

“All of these organizations are excellent examples of stakeholders no longer willing to accept the status quo and committed to improving the health and wellbeing of their workforce and value of healthcare in their communities,” said Michael Thompson, National Alliance President and CEO. “We acknowledge and highlight their efforts in the hopes that others will also learn and lead by their examples.”

The Employer/Purchaser Excellence Award is presented to a large and medium sized employer or purchaser who demonstrates leadership and innovation in advancing overall health and healthcare value through their approach to benefit programs and design, employee engagement, and support of coalitions efforts. Previous award recipients include The Walt Disney Company, Walmart, Brakebush Brothers, Southwire, East Penn International, and The Boeing Company. Read More:PRnewsWire

Bringing Healthtech Startups and Leading Payers Together to Catalyze Innovation: UCSF Rosenman Institute Announces Companies Chosen for ‘ADAPT’ Program

The UCSF Rosenman Institute announced today the startups selected in “UCSF Rosenman ADAPT,” a competitive global program for startup companies developing solutions to increase healthcare efficiency. Bold, ConsejoSano, EMME, GroupWell, Oshi, Vynca, and Woebot were selected for their innovative approaches and market promise.

The ADAPT startups will enjoy support from members of the University of California, San Francisco (UCSF) ecosystem. “We are excited to see the UCSF Rosenman Institute take a leading role in facilitating interactions between healthtech innovators and established companies with national networks,” said Sam Hawgood, MBBS, UCSF Chancellor and Arthur and Toni Rembe Rock Distinguished Professor. “Innovations that help patients better understand, manage, and access treatment are an important component of advancing healthcare worldwide.” Read More: PRNewsWire

Employee health insurance: Will companies make changes under Biden?

What changes, if any, do employers plan to make in response to Biden’s health care reform plans? In a recent webcast, Mercer asked HR professionals how their plans and priorities would change under a Biden presidency. See what they said. Read More: BenefitsPro

Mira Raises $2.7M for its Healthcare Membership Solution for the Millions of Uninsured Americans

For the millions of people in the US without health insurance (30M+) and for those that are underinsured (56M+), visiting the doctor for a routine checkup or when feeling under the weather can be a catastrophic expense. Mira allows people without insurance to receive preventative and urgent care at an affordable and accessible price point.  The platform operates on a membership model with monthly dues ranging from $25 – $45. Members have access to a network of partner clinics that they can visit with an additional $99 fixed copay that includes the office visit, lab tests, and additional procedures at no extra charge. Mira’s offers 125 clinics, 1600 labs, and 60,000 pharmacies in its provider network. Read More: AlleyWatch