How Do Plans and Providers Envision the Seamless Flow of Information?

Health IT market research

Recently, health plans and providers shared their candid thoughts on how they want to improve the flow of information throughout the ecosystem and what it will take to optimize their workflows to achieve seamless healthcare information exchange. They offered their ideas to Holon through in-depth discussions.

Holon and its research partner brought together more than two dozen health plan representatives, clinicians, provider support staff members, and health system executives to discuss their experiences. Throughout the research, participants suggested what their preferred solutions for coordinating the delivery of high-quality care might look like and ways that they might achieve clinical objectives while making life easier for clinical teams, too.

The results from this series of 60-minute interviews and 90-minute focus groups highlight deeply seated frustrations – as well as concrete, forward-thinking steps to resolve longstanding problems – in the health technology environment.

Participants stressed the need for the right mix of health IT innovations and administrative process improvements to break down communication silos and stay abreast of changes. They also provided opinions on what they want from a technology solution.

What payers and providers want

Key findings of the research include:

  • 61 percent of clinicians cite prior authorization processes as their top challenge.
  • 60 percent of provider support staff stated that time spent on the phone with payers is their major concern.
  • The vast majority of payers and providers are actively searching for digital tools that meaningfully address gaps in care and coding to support comprehensive care and financial success with value-based care contracts.
  • Consistent user experiences and seamless communication (both internally and externally) are high-priority items for payers and enterprise executives.

As healthcare’s new era of information continues to put pressure on the whole ecosystem to open up data silos and proactively communicate about administrative and clinical needs, health plans and provider groups are showing willingness to invest in high-value platforms.

One payer commented, “If providers have a portal that doesn’t work then they fall back on faxing. I don’t know who’s faxing anything, but somehow they fax and that’s inefficient for us.” And inefficiencies are costly in terms of time and enterprise performance as well as inpatient and member satisfaction.


Solving for today’s challenges

The rise of value-based care has brought about fundamental changes in the way business partners work together for the good of the patient. Health plans, healthcare delivery systems, and other complementary service providers now need to communicate quickly and more comprehensively than ever before.

But the traditional healthcare environment isn’t set up to support proactive, timely, and holistic sharing of information across organizational lines. Data silos, competing business incentives, and legacy technologies make it difficult to share data appropriately and collaborate effectively around each patient’s clinical and non-clinical needs.

When participants were introduced to the concept of an intelligent technology platform that automatically consolidates information and communications from multiple internal and external sources, they were interested. “This is what we’ve been looking for,” said one staff member. “It has a lot of the different things that we need.”

Discussions also highlighted the need for a personalized solution that would serve the needs of each enterprise, each team, and each individual on the team.

To learn more about how health plans and health systems are addressing their information and communication needs, check out our latest white paper, What Do Health Plans And Providers Want?