Hype Cycle for Healthcare Payer Organization Technologies, 2003

Transcription

1 J. Young, C. Burghard, W. Rishel, J. Galimi, J. Klein Strategic Analysis Report 13 June 2003 Hype Cycle for Healthcare Payer Organization Technologies, 2003 In 2003, critical technologies on our Hype Cycle for healthcare payer organizations support application integration, data exchange and data presentation. Management Summary In 2003 and beyond, healthcare payer organizations (payers) face three key business challenges: To establish an automated and efficient business environment to reduce costs To move from being a transaction processor to an information manager by leveraging transaction information to better manage financial and clinical resources To manage consumer involvement in financial and care decisions through more efficient administration and information exchange As payers evolve to fulfill these needs, automation and information management demands will increase through Technology will play a critical role in healthcare payer success in meeting these challenges. Technologies in this Hype Cycle will have a significant impact on healthcare payer business efficiency and performance. Their positioning on this Hype Cycle may differ from their positioning on other Hype Cycle because of unique factors in healthcare technology and application evolution. Gartner Entire contents 2003 Gartner, Inc. All rights reserved. Reproduction of this publication in any form without prior written permission is forbidden. The information contained herein has been obtained from sources believed to be reliable. Gartner disclaims all warranties as to the accuracy, completeness or adequacy of such information. Gartner shall have no liability for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. The reader assumes sole responsibility for the selection of these materials to achieve its intended results. The opinions expressed herein are subject to change without notice.

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3 CONTENTS 1.0 The Hype Cycle On the Rise Recommendation Engines (Personalization) Wireless Wide-Area Networks At the Peak Natural Language Processing Biometrics Sliding Into the Trough Intelligent Agents/Push Technology Artificial Intelligence Service-Oriented Integration Architecture Health Level 7 Version 3 Messaging Climbing the Slope Integrated Workflow Rules Technologies Web Services Entering the Plateau Computer-Telephony Integration Integration Broker Document Imaging Conclusion...10 Appendix A:Hype Cycle Definitions...11 Appendix B:Acronym Key June

4 FIGURES Figure 1. Hype Cycle for Healthcare Payer Organization Technologies, June

5 1.0 The Hype Cycle Visibility Key: Time to Plateau Less than two years Twotofiveyears Natural Language Processing Wireless Wide-Area Networks Biometrics Intelligent Agents/Push Technology Artificial Intelligence Five to 10 years Obsolete before Plateau Integration Broker Service- Oriented Integration Architecture Computer- Telephony Integration Document Imaging Recommendation Engines (Personalization) Health Level 7 Version 3 Messaging Web Services Rules Technologies Integrated Workflow As of June 2003 Technology Trigger Peak of Inflated Expectations Trough of Disillusionment Slope of Enlightenment Plateau of Productivity Maturity Source: Gartner Research (June 2003) Figure 1. Hype Cycle for Healthcare Payer Organization Technologies, On the Rise 2.1 Recommendation Engines (Personalization) Definition: Recommendation engines evaluate the results of predictive models and make recommendations for future behavior. Time to Plateau/Adoption Speed: Five to 10 years. Justification for Hype Cycle Position/Adoption Speed: Recommendation engines have been deployed very little in the healthcare payer market. A few niche vendors are using recommendation engines to tell consumers how to reduce their healthcare expenses. Early work to develop care management paths is also emerging. Business Impact Areas: The initial impact of recommendation engines is related to reducing out-of-pocket medical expenses for consumers. Long term, recommendations that are directly related to healthcare delivery will occur after Analysis by Cynthia E. Burghard 13 June

6 2.2 Wireless Wide-Area Networks Definition: Wireless wide-area networks (WWANs) extend wireless coverage from feet to miles. The greatest value of WWANs comes from their support of consumer-focused clinical management initiatives. Time to Plateau/Adoption Speed: Five to 10 years. Justification for Hype Cycle Position/Adoption Speed: Wireless technology has not yet been implemented for healthcare payer, care management initiatives. The business and IT infrastructure will not be ready for WWANs until at least Business Impact Areas: The evolution of WWANs affects healthcare payers' timelines as well as the success of online care management programs and sales initiatives. Analysis by Janice Young and Cynthia E. Burghard 3.0 At the Peak 3.1 Natural Language Processing Definition: Natural language processing (NLP) translates natural language input into the logic of the knowledge or processing database. Time to Plateau/Adoption Speed: Five to 10 years. Justification for Hype Cycle Position/Adoption Speed: There is very little deployment of NLP in the healthcare payer market, with just one vendor focusing on NLP as a core application attribute in Healthcare payers will focus on other proven technologies to improve efficiency before they focus on NLP. Business Impact Areas: NLP is potentially a high impact technology because it can streamline of healthcare payer administration, particularly in the areas of managing benefits and provider contracts. Analysis by Janice Young 3.2 Biometrics Definition: Biometrics uses physiological or behavioral traits to identify a person. Time to Plateau/Adoption Speed: Twotofiveyears. Justification for Hype Cycle Position/Adoption Speed: The U.S. Health Insurance Portability and Accountability Act (HIPAA) privacy and security requirements, an increasingly mature biometrics market, and customer concerns regarding privacy will drive the adoption of biometrics. For a general market assessment of biometrics, see "Hype Cycle for Information Security, 2003," R Business Impact Areas: The use of biometrics will enable healthcare payers to establish the application and data security needed to comply with security and privacy regulations, and attract and maintain customers. Analysis by Jim Klein 13 June

7 4.0 Sliding Into the Trough 4.1 Intelligent Agents/Push Technology Definition: Intelligent agents/push technology is software that automates the delivery of information by initiating contact through a Web browser, , voice device or pager, based on predefined rules. Time to Plateau/Adoption Speed: Five to 10 years. Justification for Hype Cycle Position/Adoption Speed: Healthcare organizations are beginning to experiment with push technology. Poor data quality as well as security and privacy issues are impeding rapid and widespread adoption of push technology or intelligent agents. Business Impact Areas: Intelligent agents/push technology will enable healthcare payers to collaborate with consumers to improve quality of care. Analysis by Cynthia E. Burghard 4.2 Artificial Intelligence Definition: Artificial intelligence technology consists of computer-based software and algorithms that mirror humans' capacity for learning, contemplation and judgment. Time to Plateau/Adoption Speed: Five to 10 years. Justification for Hype Cycle Position/Adoption Speed: Although artificial intelligence technology maturity in healthcare is consistent with its maturity in other industries (see "Hype Cycle for Advanced Analytics, 2003," R ), it only has had limited use to detect fraud and abuse, and most recently for predictive modeling. Immature adoption of artificial intelligence technology for healthcare payer applications and continuing data challenges will continue to limit its use. Business Impact Areas: Artificial intelligence potentially will have a big impact on supporting better contract and pricing methodologies, identifying fraudulent billing practices and identifying populations where care management resources can be effectively deployed. Analysis by Cynthia E. Burghard 4.3 Service-Oriented Integration Architecture Definition: The term "service-oriented integration architecture" (SOIA) refers to application program interfaces, which are based on the principle of service-oriented architecture, that facilitate tight integration with underlying or third-party applications. Time to Plateau/Adoption Speed: Twotofiveyears. Justification for Hype Cycle Position/Adoption Speed: SOIAs have not yet implemented in 2003, but many healthcare application vendors are pushing their SOIA architecture development to create products that will be delivered from mid 2004-through mid For a general market assessment of SOIA, see "Hype Cycle for Application Development, 2003," R Business Impact Areas: SOIAs will have a big impact on healthcare payers. They will improve businessprocess efficiency across the enterprise and establish the business automation required for a real-time environment. Analysis by Wes Rishel and Janice Young 13 June

8 4.4 Health Level 7 Version 3 Messaging Definition: Health Level 7 (HL7) v.3 messaging is targeted at providing robust standards for sharing structured clinical data. Time to Plateau/Adoption Speed: Less than two years. Justification for Hype Cycle Position/Adoption Speed: To support consumer-driven health plans, healthcare payers must adopt standards that facilitate the integration of administrative, financial and clinical information. Healthcare payers and vendors will move to adopt the HL7 v.3 messaging standard to support business requirements. In addition, HL7 v.3 takes advantage of XML messaging, leveraging both core and integration architecture evolution. Business Impact Areas: The HL7 v.3 messaging standard supports the creation of an integrated outcome data set to enable healthcare payers to make better consumer and provider healthcare benefit and resource decisions, but the results depend on how this integrated data is used. Analysis by Wes Rishel and Janice Young 5.0 Climbing the Slope 5.1 Integrated Workflow Definition: Integrated workflow is technology that is used to automate and track healthcare business processes and handoffs for decision making through users' customized models, not just through templated workflow tools. Time to Plateau/Adoption Speed: Twotofiveyears. Justification for Hype Cycle Position/Adoption Speed: Tools for external customizable workflow have been available for some time, but with limited adoption. By mid-2005, many vendors will have implemented integrated workflow within their architectures to supplement application workflow, provide a greater degree of dataflow capacity and reduce reliance on external products. Business Impact Areas: Integrated workflow will promote business efficiency and establish the business automation required for real-time health plans. It will also enable healthcare payers to respond to changing business requirements. Analysis by Janice Young 5.2 Rules Technologies Definition: Rules technologies separate out, or abstract, the business knowledge of an application from the procedural programming logic and implementation details to facilitate a consistent application of rules to a transaction. Time to Plateau/Adoption Speed: Twotofiveyears. Justification for Hype Cycle Position/Adoption Speed: External rules engines are available and increasingly sought by healthcare payers. All core administrative vendors are planning to enhance rules technologies in their application development through Business Impact Areas: Rules technologies will increase healthcare payer process automation, and reduce the number of manual transactions that are performed and transaction rework. 13 June

9 Analysis by Janice Young 5.3 Web Services Definition: Web services are technologies that use the Web to allow healthcare payers to connect applications in a technology-neutral fashion. Web services will be used among applications within the healthcare payer organization and between healthcare payer applications and those of other stakeholder enterprises. Time to Plateau/Adoption Speed: Twotofiveyears. Justification for Hype Cycle Position/Adoption Speed: In 2003 and 2004, many healthcare payer application vendors are planning to deploy Web services technologies. These will not be deployed on referenceable customer sites until at least mid Extending the mainframe through Web services is possible, but the full toolset for healthcare payers will not mature until mid Business Impact Areas: Web services will extend business processes, improve process automation and support real-time initiatives. Analysis by Wes Rishel and Janice Young 6.0 Entering the Plateau 6.1 Computer-Telephony Integration Definition: Computer-telephony integration (CTI) technology manages the interfaces between call center services, back-end databases and customer service representatives' desktops. Time to Plateau/Adoption Speed: Less than two years. Justification for Hype Cycle Position/Adoption Speed: CTI technologies are reaching maturity, and their return on investment has been proven in other industries. Adoption and integration into healthcare payer vendor applications has increased rapidly since Business Impact Areas: CTI is high impact because it will streamline the application integration required for more responsive customer service and facilitate the corresponding customer retention. Analysis by Joanne Galimi 6.2 Integration Broker Definition: Integration broker technology is system software that resides between applications and facilitates communication between them. Time to Plateau/Adoption Speed: Less than two years. Justification for Hype Cycle Position/Adoption Speed: Despite vendor hype to the contrary, application heterogeneity will persist for healthcare payers. Legacy applications will be leveraged for as long as possible; however, establishing an enterprise architecture strategy with integration brokers is required for any success in today's and future markets. Business Impact Areas: Integration brokers will be critical for healthcare payers to manage short- and long-term application heterogeneity, and to support the automated and real-time enterprise. Analysis by Janice Young and Wes Rishel 13 June

10 6.3 Document Imaging Definition: Document imaging refers to the capability to create scanned electronic versions of paper documents to improve workflow, data entry processes and transaction automation. Time to Plateau/Adoption Speed: Less than two years. Justification for Hype Cycle Position/Adoption Speed: There may be a brief surge in document imaging requests from healthcare payers in 2003 and 2004 if they are unable to meet HIPAA compliance standards for electronic submission. However, longer term, document imaging as a discrete technology will become obsolete due to the high level of electronic transactions and the need to combine document imaging with workflow for effective support of paper exception processing. Business Impact Areas: Document imaging will continue to have a high short-term impact (three to five years). Longer term, it will continue to be part of the arsenal of healthcare payer technologies, but it will be used less as the number of Web transactions increases. Analysis by Janice Young and Jim Klein 7.0 Conclusion In 2003, key healthcare payer technologies will enable better information integration and exchange to support more automated business processes, increase business efficiency and make better use of information for decision making. In general, healthcare payers should maintain a portfolio of low-risk technologies, with known potential and return on investment, as well as a sprinkling of newer and higherrisk technologies. Gartner recommends that Type B enterprises (moderate adopters of new technology) consider the following tactics: Now adopt CTI, document imaging and integration brokers. By 2Q04 assess today's external workflow solutions and external rules engines as technologies to adopt to extend legacy application performance. From mid-2005 through mid-2006 watch biometrics, Web services, SOIA, enhanced, configurable, customizable rules engines that are embedded within application processing technologies, and intelligent agents/push technologies as technologies to adopt. Defer Investments in NLP, WWANs, recommendation engines/personalization and artificial intelligence. 13 June

11 Appendix A: Hype Cycle Definitions Technology Trigger: A breakthrough, public demonstration, product launch or other event generates significant press and industry interest. Peak of Inflated Expectations: During this phase of overenthusiasm and unrealistic projections, a flurry of well-publicized activity by technology leaders results in some successes, but more failures, as the technology is pushed to its limits. The only enterprises making money are conference organizers and magazine publishers. Trough of Disillusionment: Because the technology does not live up to its overinflated expectations, it rapidly becomes unfashionable. Media interest wanes, except for a few cautionary tales. Slope of Enlightenment: Focused experimentation and solid hard work by an increasingly diverse range of organizations lead to a true understanding of the technology's applicability, risks and benefits. Commercial, off-the-shelf methodologies and tools ease the development process. Plateau of Productivity: The real-world benefits of the technology are demonstrated and accepted. Tools and methodologies are increasingly stable as they enter their second and third generations. The final height of the plateau varies according to whether the technology is broadly applicable or benefits only a niche market. Approximately 30 percent of the technology's target audience has or is adopting the technology as it enters the Plateau. Time to Plateau/Adoption Speed: The time required for the technology to reach the Plateau of Productivity. 13 June

12 Appendix B: Acronym Key CTI HIPAA computer-telephony integration Health Insurance Portability and Accountability Act HL7 Health Level 7 NLP SOIA WWAN natural language processing service-oriented integration architecture wireless wide-area network 13 June