Oracle sharpens focus on the healthcare payer market

IDC Health Industry Insights Community –

At Oracle Open World in San Francisco, Oracle made two key announcements that portend a more focused strategy and presence in the US and global healthcare payer market. On September 20, Oracle announced an agreement with Harvard Pilgrim Health Plan to develop a core healthcare payer administrative application. This follows an Oracle's announcement in August 2010 of a revenue cycle management and billing application for healthcare payers. Additional presentations at Oracle Open World this week include the extension of the Oracle customer service solution sets to support individual and group market quote to card solutions. The solution has been implemented in 2010 at WellPoint.

The announcements at Oracle Open World reflect the company's much more organized emerging strategy for the healthcare payer market. Oracle healthcare payer solutions, built on service oriented, business rule and workflow technologies, are emerging options to watch for the healthcare payer industry. Among the key differentiators of the solutions are:

  • Component strategy: The core claims solution is architected to be implemented in components, reducing the risk and costs of big bang implementations. The Harvard Pilgrim Health Plan implementation will be the initial and early adopter implementation of the component strategy.
  • International experience: Oracle brings experience in the international health care payer market place. Of interest is the world wide focus on healthcare insurance models, cost controls, quality improvement and legislated technology and code mandates, such as ICD-10. Notably, as the US market moves introduces new individual models and government programs increase; other countries have already introduced individual and commercial programs in tandem with, or in replacement of, government programs. Oracle has strong experience implementing and managing programs in individual, government, group/employer and blended markets. The organization has and are blending strong international and US resources to meet both US and international market needs.
  • Payer/provider experience: A previous blog discussed the growing investment by healthcare payer vendors (TriZetto, Ingenix) in provider assets and technologies. As the market evolves toward increasing collaboration (including HIE, accountable care organizations and the medical home), vendor experience and solutions across market will be invaluable to reduce redundancy, improve integration, process and information access.
  • Breadth of technology and partner solutions: Oracle an extensive array of healthcare technology resources for health care payers, including claims processing, CRM, business intelligence as well as the strong underlying database and integration tools. Additional applications of technologies to support care management are also in development. Partnerships exist with most prominent consultant/systems integration and services vendors.

Oracle's healthcare payer solutions strategy are a work in progress; Oracle's assets, new clients and corporate focus represent a strong emerging commitment to the healthcare payer market. We expect further organizational alignment and early adopter implementations of key strategic solutions to meet the US reforming market to occur within the next 12 months.

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