The Current Healthcare Environment
The healthcare environment today faces challenges that it has never seen before. The industry is under attack from every possible direction from cost containment, HIPAA (Health Insurance Portability & Accountability Act) compliance, lack of stability, to an uncertain future. After trying various managed care techniques and concepts the onus to contain costs is now on the healthcare consumer.
Concepts such as defined contribution mutated into various consumer driven health plans are being touted as the nirvana pill for an aching industry. Medical and disease management is expected to play a key role for payors as they try to manage healthcare delivery. While executives are trying to grope for answers in an ever changing environment, the light at the end of the tunnel seems far away and a dim one at that. Regardless of the concepts that will or will not be around three years from now, one thing is certain, the degree of COMPLEXITY is increasing by the day.
Healthcare Payors are facing the following points of pain: 1. Managing increasing medical costs and balancing customer satisfaction
2. Reducing operating back-office costs
3. Complying with HIPAA standards and requirements
4. Upgrading IT infrastructure and moving to the web to provide real-time connectivity
5. Focusing on survival and developing a strategy to differentiate products from other incumbents and new players
Value Chain vs. Value Chain Competition
The healthcare benefit administration value chain is unlike any other. While the manufacturing value chain is easy to decipher and understand, this one is as arcane to do so. The complexity coupled with the dynamism has given rise to multiple organizations offering very specialized services and working together to form the value chain. The final result of this