Health insurance companies and other healthcare payer organizations are going to spend nearly $550 million this year on technologies that help them compete in a changing marketplace — a marketplace that is finally becoming more consumer centric due to the Affordable Care Act (ACA) and new regulatory requirements.
Indianapolis-based software developer Healthx is poised to capture a large individual share of that spending by integrating the healthcare ecosystem with its leading cloud-based platform that brings together disparate data systems and processes into a single, unified database that powers branded portals for the healthcare industry.
Similar to the revolution we’ve seen in online banking, the portals Healthx creates cover 22 million lives and make healthcare easier for everyone involved — from consumers and patients to healthcare providers and payers.
It’s the payers who are the primary customers Healthx targets. These include:
- TPAs (Third Party Administrators)
- Small to mid-sized commercial health plans (up to 2.5 million covered lives)
- Government health plans: Managed Medicaid, Medicare Advantage
- Accountable Care Organizations / Value-based care
If your health plan offers online access to information and self-service functions like downloading EOBs (Explanation of Benefits) or printing a new ID card, you might already be using the Healthx platform and not know it because it’s always branded with the customer’s name and logo.
Win NortonCo-founder & CTO
For example, looking at three different types of common healthcare transactions — preauthorizations, claim inquiries and eligibility inquiries, transactions that touch patients, providers and payers alike — Healthx was able to save its customers $305 million by automating tasks or streamlining processes through the provider portal.
It’s not just about reducing costs, though. Key provisions in the ACA require healthcare providers and payers to share some financial and clinical risk, meaning that they are paid based on patient outcomes rather than just the number and kind of services provided. With the Healthx platform, patients are much more engaged with their own healthcare, which is critical to better outcomes and higher reimbursements for the providers and payers.
According to Norton, prior to 2010 many health plans would simply have created their own basic portals, or used off-the-shelf add-on platforms that are packaged with other IT solutions like claims processing software. But with the ACA and new regulations shifting the industry to consumer-centric healthcare, the need for a more powerful and sophisticated portal solution is required to provide patients with tools and resources to help them improve their health.
The competitive landscape for Healthx isn’t particularly crowded and the company enjoys a solid market reputation and fierce loyalty with a 97 percent renewal rate among its 180 healthcare payer customers.
When a larger, multibillion-dollar competitor recently offered to give its entire platform to one of Healthx’s paying customers for free, that customer still said “no thanks.” There are only a handful of top-tier portal providers, but the competitive landscape is complicated by the tendency for most larger health plans to hire an army of software developers and attempt to create their own portal.
“Most health plans don’t have the expertise to build a solution in-house, particularly when it comes to responsiveness, mobility and long-term compliance and security” Norton said. “This is where Healthx comes in. We provide better portals to help patients, providers and payers collaborate and navigate the new frontier of healthcare together.”
Originally founded in 1998, Healthx has been at the forefront of the application of the internet in healthcare environments since the beginning. In fact, they were early pioneers providing healthcare payers software-as-a-solution platforms, and they were the very first company to go all-in with multi-tenant, cloud-based solutions for the healthcare space.
The company’s growth has been consistent for many of its 18 years, but with the ACA and new regulations driving urgency for consumer-centric care delivery, Healthx is earning the business of larger and larger payers and they have booked more first-year contract value in the first six months of 2016 than they did all of last year.
This accelerated growth is one of the reasons the company is aggressively hiring in all areas and actually doubling its engineering talent. Healthx currently employs 117 with plans to hire approximately another 25 people through 2017.
1 Nearly $550 million potential market size spend based on an independent study commissioned by Healthx.
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