Readers Write: The Importance of Accurate Benefits Data in Healthcare

The Importance of Accurate Benefits Data in Healthcare
By Gary Davis

Gary Davis is national practice leader for Noyo of San Francisco, CA.

In the world of healthcare IT, there is so much to talk about. Digital transformation, automation, and new tech in the US health system is paramount, holding the promise of improved patient experiences, better health outcomes, and reduced costs, not to mention alleviating burden and burnout among healthcare workers. This crucial topic in healthcare today runs the gambit, covering everything from super advanced tech like artificial intelligence and blockchain to wearables, remote patient monitoring, telehealth, and interoperability among EHRs and other data sources like HIEs and more. 

I am here to address a less-sexy but important healthcare data topic – accurate insurance benefits data.

About 46% of Americans have employee-sponsored insurance benefits. The top benefit in the mix is healthcare insurance. Insurance benefits are focal to all our lives. It’s how we maintain health and wellness through healthcare, dental, and vision coverage.

Right now, many people are in the thick of the open enrollment season, making selections and completing enrollment paperwork, with teams of benefits administrators, HR, brokers, and insurance carriers fast at work getting everything complete and ready for the coming new year of coverage.

When I say “paperwork,” I mean it literally. The insurance industry is ripe for a technology upgrade. In 2023, carriers continue to rely on paper, web portal entry, email, phone, and electronic data interchange (EDI) for data exchange to support important functions of enrollment and member changes. The last major tech advancement in the insurance industry was EDI, and that was back in the 1970s.

Why the slow pace? The status quo is often the sector’s biggest hurdle. Paper-based systems and manual data entry dominate industry workflows. Many leaders think that it works, but not really. Manual data entry is fraught with inaccuracies and data sits in silos and is inaccessible. The lagging tech makes it challenging for benefits software, insurance carriers, brokers, and employers to keep key employee information in sync and drive innovation.

Our insurance benefits are confusing and hard to use, which that often means that services and money are left on the table by many. Just 9% of employees understand benefits terms like co-insurance. Meanwhile, choosing the wrong health plan can be a $2,000 mistake.

A 2023 Harris Poll consumer survey of 2,000 employed adults with employer-sponsored insurance benefits revealed that nearly half the respondents cited frustration when using their insurance benefits because they are hard to understand. Meanwhile, two in five indicated they have received inaccurate bills, have been unable to access care, or that their family has been negatively impacted due to delays because of errors in their insurance coverage.

Plus, because they don’t clearly understand what their benefits offer, many people wait to use their healthcare coverage until a health crisis hits, which isn’t good for the individual, population health, or payers.

In 2024, we predict that modern, frictionless benefits will take hold, enabled by API technology. These are benefits that are easy to use and to personalize to match the needs of individuals. Foundational to this new path forward, though, is accurate benefits enrollment data. There is a lot of inaccurate enrollment data out there, due in large part to decades-old technology in place in the insurance benefits ecosystem. The bad data is getting in the way of innovation and of people better who are understanding and using their benefits to their fullest.

API technology will pave the way forward. Payer organizations should have an API strategy and roadmap to guide them. You can build it yourself or team up with a trusted, visionary partner. Either way, 2024 should bring business imperatives to replace the technology status quo in the industry.