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Gartner Hype Cycle for Healthcare Payers, 2024 Gartner Hype Cycle for Healthcare Payers, 2024

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    Reporting

    • The State Regulatory Guidance (All Plan letters) responsibilities include, but are not limited to:
      1. DHCS All Plan Letter (APL) and Policy Letter (PL) Applicable Notices
      2. DHCS All Plan Letter (APL) and Policy Letter (PL) - Non-Applicable Notices
      3. Submits proof of APL and PL compliance documents to DHCS
    • The Organization Risk Assessment responsibilities include, but are not limited to:
      1. Review of new potential risks with assigned accountable business owners
      2. Provide final data set to senior executive team for implementation of agreed upon interventions
    • The Regulatory Audit Process responsibilities include, but are not limited to:
      1. Creation of audit folders
      2. Tracking of documents/universe and requests received from the auditor and distributed to the business owners
      3. Audit Readiness Questionnaires
    • The Regulatory Routine Reporting responsibilities include, but are not limited to:
      1. Maintaining calendar for all regulatory compliance
      2. Tracking timeliness of business owner’s submissions and attestation

    Monitoring

    Continuous monitoring allows a health plan to quickly and easily keep its finger on the pulse of the delegates’ performance to identify potential risks or issues before they become major problems. This will help ensure compliance with needed regulations through the health plan’s ability to:

    • Expedite feedback processes to mitigate operational and enterprise risks
    • Utilize streamlined reporting processes to automate reviews and highlight elements that are approaching identified tolerances
    • Track findings, recommendations and corrective action plans, as well as trends over time, to quickly compare delegates and prepare for renegotiation when the time comes

    Audit and CAP

    Auditing delegated entities is essential for maintaining good governance, managing risk and ensuring compliance within an organization. Health plans can now efficiently oversee audits and perform file reviews of their delegated entities and vendors and maintain a system-wide overview of all compliance activities:

    • Deliver real-time audit results
    • Lower audit backlog, efforts and timelines
    • Help health plans with pre- and post-delegation audits of all areas of delegation
    • Create and manage Corrective Action Plans (CAP) for all audits that produce findings

    Pre-delegation audit

    The pre-delegation audit process involves a comprehensive review of the proposed delegates’ policies, procedures, and systems, as well as an assessment of their compliance with relevant technical and operational standards. The audit may also include a review of their financial stability and management structure. Our module helps guide the process through:

    • Facility Site Review audits
    • Medical Record Review audits
    • Credentialing Audits Pre- and Annual re-certification
    • Utilization Management audits including Quality Management (QM) audits
    • Special Needs Plan (SNP) audits

    Delegation repository

    Centralized database of your various delegate or vendor information, allowing health plans to easily track and manage relationships with its FDRs.

  • Demographic information
  • Contact information
  • Responsibilities or functions assigned
  • Audit activities and past performance

    • Inovaare listed as a representative vendor in the Gartner® Hype Cycle™ for Healthcare Payers, 2024

    gartner

    Hype Cycle for Healthcare Payers, 2024, Mandi Bishop, Austynn Eubank, Connie Salgy 29 July 2024

    GARTNER is a registered trademark and service mark of Gartner, Inc. and/or its affiliates in the U.S. and internationally, and HYPE CYCLE is a registered trademark of Gartner, Inc. and/or its affiliates and are used herein with permission. All rights reserved.

    This graphic was published by Gartner, Inc. as part of a larger research document and should be evaluated in the context of the entire document. The Gartner document is available upon request from Inovaare

    Why U.S. Healthcare Payer Leaders Should Read This Report

    The Gartner® Hype Cycle™ for U.S. Healthcare Payers, 2024 provides vital input for strategic planning by tracking the maturity level and adoption rate of payer technologies and deployment approaches.

    Key benefits include:

    • Informed Decision Making: Whether you’re exploring AI possibilities, or embracing the latest technologies, this report equips you with critical Gartner insights regarding the status and potential impact of each technology.
    • Strategic Investments: U.S. healthcare payer CIOs, CTOs, and Operations leaders can use this report to make strategic decisions regarding new technology investments.
    • Enhanced Member Experience: Learn how AI and other technologies align with top payer priorities, including improving member and partner experiences and increasing operational efficiency.
    • Access to Hype Cycle Authors: Let us know if you would like to engage with the authors of this Hype Cycle and we can facilitate a meeting.

    Explore the Hype Cycle to better understand the transformational benefits of:

    • LLMs for Healthcare Payers *Inovaare Listed as a Representative Vendor
    • Consumer-Centric Health Products *Inovaare Listed as a Representative Vendor

    For insights from analysts about the future of healthcare payer technologies, request you complimentary access to this Gartner® report today!

    Access Gartner® Report


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