The program theme at the June America’s Health Insurance Plans (AHIP) Exchange Conference and AHIP’s Institute 2013 was Transforming Our Health Care System: Navigating and Succeeding in the New Marketplace.  Topics included care delivery transformation, innovation for a new healthcare eco system, Health Insurance Exchanges, the nexus of consumerism, retail and healthcare, driving value through improved operations and leveraging technology, data and innovation to transform care. Oracle participated as a sponsor of both conferences, signaling the significant investment and activity Oracle continues to make in helping health plans, providers and government agencies become more efficient and more relevant in the healthcare market place.

AHIP is a national trade association representing the health insurance industry. AHIP’s members provide health and supplemental benefits to more than 200 million Americans through employer-sponsored coverage, the individual insurance market and public programs such as Medicare and Medicaid.   AHIP advocates for public policies that expand access to affordable health care.
Health plans are focusing on the Health Insurance Exchanges and the opportunities they offer to provide better access and higher quality healthcare.  With the opportunities come operational challenges to implementation and innovative technology solutions to consider.  

At the Exchange Conference, Oracle hosted a breakfast symposium on “Strategies for Success:  Driving Business Transformation in the Growing Health Insurance Exchange Market”.

With Health Insurance Exchanges as catalysts for change, attendees learned about how to achieve integration within an Exchange and deploy new business strategies to support health reform initiatives. Discussion covered steps and processes to successfully establish and implement enrollment systems, quote to card activities, program pricing, claims billing, automated claims processing and new customer service tools.

Piyush Pushkar, COO of Benefitalign, an Oracle partner that provides solutions to adopt innovative business models for retail, HIX, consumer-centric health plan and benefits administration, spoke on the state of the Exchanges in the U.S. and the activities health plans are engaged in to support individuals entering the healthcare system, including sales automation, member enrollment automation/portals and integration strategies with the Exchanges.

The Oracle and Benefitalign partnership allows seamless integration between a health plan enrollment solution with the HIX individual market and allows for the health plan to customize and characterize the offerings available to the HIX that may or may not be available through other channels.  This approach can benefit the health plan through separation of interests, but also because some state-run HIXs require such separation.

Janice W. Young, Program Director, Payer IT Strategies, IDC Health Insights, reviewed a survey of health plans on their investment priorities for this last year as well as this year.  She also identified the 2013-2015 strategies of go/get to market with front end and compliance investments; leveraging existing business processes and internal technologies; and establishing best practices.  Of key interest to the audience was a reform era payer solutions platform overview mapping technologies to support the business operations.

David Bonham of the Oracle Health Insurance organization moderated the panel and spoke on Oracle’s presence in healthcare and products for payers to help them drive efficiencies and gain a competitive advantage in an ever changing market.

Oracle serves healthcare stakeholders with applications such as billing, rating and underwriting, analytics, CRM, enrollment, and products for processing of health insurance claims including pricing and benefits administration, as well as payment of providers through alternative, non-fee for service reimbursement methods.

Oracle in Healthcare….Did you know?

• More than 80 healthcare payers run Oracle applications.
• More than 300 leading healthcare providers run Oracle applications.
• 10 out of the top 12 fortune Global 500 healthcare organizations run Oracle applications.

For more information on Oracle solutions for healthcare payers, please visit oracle.com/insurance or these individual solution pages:

• Oracle Health Insurance Components
• Oracle Insurance Insbridge Rating and Underwriting
• Oracle Insurance Revenue Management and Billing
• Oracle Documaker
• Oracle Healthcare
• Oracle CRM

Related Resources

• Webcast On Demand: Strategies for Success: Driving Business Transformation in the Growing Health Insurance Exchange Market
• Strategy Brief: Executing on the Individual Mandate: Opportunities and Challenges for Healthcare Payers
• White Paper: White paper: Navigating Alternative Provider Reimbursement Models of the Future
• Strategy Brief: Enterprise Rating Agility Improves Payer Response to Healthcare Reform
• Podcast: Technology Implications of Healthcare Reform

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