Gartner Research

U.S. Healthcare Administration’s Future Requires a Real-Time Payment Ecosystem Powering Value-Based Care

Published: 27 November 2018

ID: G00373354

Analyst(s): Barb Mann, Bryan Cole, Mandi Bishop

Summary

Claims denials, rework and lagging payments sap efficiency from the U.S. healthcare system — draining profits from payers and providers alike. CIOs must use this model to guide development of real-time payment processes in support of value-based care to improve consumers’ health outcomes.

Table Of Contents

Analysis

  • Healthcare Payment Inefficiency Yields High Cost, Poor Quality and Consumer Frustration
    • Skepticism and Historical Antagonism Limit Obvious Solutions
  • Real-Time Payments Enable Value-Based Care
  • Introducing the Gartner Real-Time Payment Model
    • The Model Starts With Scope and Basis
    • The Model Adds Reinforcing Actions
    • The Model Depends on Supporting Technologies
  • Interaction Technology Changes Marry Payers’ and Providers’ Real-Time Transactions
    • Portals Become Hubs
    • Clearinghouses Become Direct Exchanges
    • Discontinuities Become Reconciliations
  • Use Gartner’s Real-Time Payment Model to Develop Your Technology Roadmap

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