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The Digital Future of Payer Operations: Achieving Our Quintuple Aim

Healthcare Professional

The healthcare information technology ecosystem is always evolving. Concepts such as digital health, digital transformation and healthcare interoperability are frequently used to describe trends and the future of what traditionally has been called healthcare IT. GeBBS continuously monitors developments and evaluates their impact on its strategy, products, and customers.

Even within payer organizations, digital transformation can have many facets, from core business operations to administrative functions such as human relations. Arguably the most significant digital transformation under way pertains to core payer operations driven by the changes in clinical data interoperability. One of the latest of those is FHIRยฎ (Fast Healthcare Interoperability Resources: pronounced โ€œfireโ€), which is a standard for exchanging healthcare information electronically using web technologies.

In this paper we seek to clarify what we mean by true interoperability in healthcare IT, while presenting a comprehensive view of how the need for and access to structured clinical data will soon drive a dramatic shift in payer operations.

In GeBBSโ€™ strategic assessment, several highly significant changes are happening in the healthcare IT ecosystem. Specifically, regulations related to interoperability and other policies, as well as business and market forces, will change how payers will need to operate in the foreseeable future. Interoperability is already changing how patients participate in and take control of their own health and healthcare, and that is just one of many changes yet to come.

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