A Rock and a Hard Place
Have you ever wondered where the phrase stuck between “a rock and a hard place” originated? Recently, as I considered IT and medical loss ratios (more on this in a minute), I pondered the origin of this phrase. As is my typical M.O., I turned to Wikipedia for the answer and found that the phrase refers to Morton’s Fork – a superficially plausible, but actually wrong argument that leads to an unfavorable conclusion.
Thanks to my high school European History teacher, I immediately thought of the “She’s a witch!” version of the dilemma from Monty Python and the Holy Grail. In the skit, through a dizzying array of logic, it’s concluded that if a person floats like wood or a duck, then he or she must be a witch.
At this point, it may appear that I have strayed far from anything related to healthcare IT; however, if you have a few more minutes, follow me through my own dizzying logic as I bring us back to point.
Medical Loss Ratio
Medical Loss Ratio (MLR) is a rule put in place as part of the Affordable Care Act. In short, and in admittedly over-simplified terms, MLR limits the amount that most healthcare payers can use for business expenses, other than paying their customers’ medical claims, to 20% of their premiums. If an insurer exceeds this ratio, they must return the excess to their customers.
Where most other business may use quality branding, better sales, superior customer service and other tools to maximize margins; insurers have fewer options to accomplish the same task. At the same time, the need to grow top line revenue (still within the legal limits for profit) does not allow payers to ignore marketing and sales, it is just that the only benefit they may achieve is top-line growth.
As is the case with being “between a rock and a hard place,” insurers are presented with limiting options, which require an even greater focus on operational efficiency. For those of us with a long history in IT, it is at this point that we get hallucinations of Dilbert’s pointy haired boss telling us to “do more with less.”
The Other Shoe is About to Drop
While the need for operational efficiency isn’t new in any industry, healthcare providers and payers are now being forced to evolve more quickly than ever before. While healthcare payers had their business options limited by MLR, healthcare exchanges, consolidations, ACOs, and other business and regulatory changes are creating an environment that is more competitive than ever before.
As if increased competition isn’t enough, the complexity required of businesses to survive, and even thrive, as a healthcare payer is growing. Healthcare payers must bring full time and part time employees on at an ever-increasing rate. When those employees leave the organization, there is the risk of protected health information (PHI) being managed incorrectly, thus making it imperative that the off-boarding process is accomplished in a manner both timely and correct.
IT departments for healthcare payers not only need to support employees and contractors, but they are often called on to extend that support to vendors that provide services ranging from healthcare bill review to complex data analytics. These vendors often have similar access to the PHI as employees, so they must be handled with equal rigor to ensure that patient records are handled safely.
IT organizations supporting healthcare payers today are stuck between the rock of limited business options and the hard place of one of the most complex user environments in existence. Pile on the fact that they support one of the most compliance and security sensitive industries and you have rock, a hardplace and a duck. I assure you though there is a solution and it isn’t witchcraft.
Self-Serving Marketing Message
RES Software understands healthcare, from technology trends like Virtual Desktops and BYOD used heavily in healthcare to the unique security implications of PHI. RES Software has spent time to understand the unique challenges of the healthcare industry and designed specific solutions and workflows around those challenges. What other single solution can handle your needs from automated IT self-service and off boarding to securing USB ports?
If you want an IT partner in healthcare that understands not just your technology needs but also the unique business drivers behind them, RES Software should be on your short list.
Meet us at Summit of the Southeast on September 16th and 17th in Nashville. Let’s discuss your pain points and see how our technology can help you resolve some of those healthcare IT issues.