Interoperability: Beyond the Clinical Side of Healthcare

Growing need for interoperability

Healthcare reform is driving a greater need for efficiency, resulting in the formation of Accountable Care Organizations (ACOs) and provider consolidation.  As provider organizations using different systems work together, there is a much greater need to integrate heterogeneous environments to achieve system interoperability.  However, healthcare information is often not easily exchanged among providers because of paper-based processes or systems that are not compatible.  In fact, 71% of providers surveyed said the lack of system interoperability is a major barrier to health information exchange (Bipartisan Policy Center).

Top industry initiative: Clinical interoperability

Many provider organizations are already focused on clinical system interoperability, such as sharing information across medical devices and electronic health record systems.  If clinical interoperability is achieved, the healthcare industry could save more than $30 billion annually according to a report by the West Health Institute.

Much more to accomplish than clinical interoperability

To save more money, the industry will need to expand its focus on interoperability to the administrative side of healthcare, including payment-related systems and processes.  As patient responsibility continues to grow, providers will need to collect more patient payments, especially when 30 million uninsured Americans begin to receive healthcare coverage under PPACA.  And if patient payments are not managed efficiently, it can cost providers three to five times more to collect than payer payments due to paper-based, manual processes (McKinsey Quarterly).

Creating administrative interoperability within heterogeneous environments

The industry will need to focus on interoperability in the administrative side of healthcare, including the clearinghouse, patient billing and payment transactions required for the healthcare payments process.  By integrating healthcare payments across heterogeneous environments, providers and payers will automate more administrative processes, simplify compliance requirements and streamline employee training, resulting in lower operational costs and more money collected.

For more on system interoperability and other healthcare payments industry trends: click here.

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