Perspective: Cloud Solutions and Deployment for Healthcare Payers in 2014

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1 Perspective Perspective: Cloud Solutions and Deployment for Healthcare Payers in 2014 Lynne A. Dunbrack Judy Hanover IN THIS PERSPECTIVE This IDC Health Insights Perspective examines the current status of cloud deployment by U.S. healthcare payers and their plans for cloud initiatives in 2014 and includes data from IDC Health Insights' 2014 Healthcare Payer IT Investment Survey. The survey findings indicated that cloud adoption is widespread among payers; most payers are currently using cloud computing, planning to deploy cloud within the next year, or researching options. This Perspective explores the adoption of cloud; spending, priorities, and expected benefits from the deployment of cloud computing; and key workload payers moving to the cloud in Payers can use the findings of IDC Health Insights' 2014 Healthcare Payer IT Investment Survey to benchmark their use of cloud technologies against their peers. Methodology IDC Health Insights conducted a telephone-based survey to gauge payer plans for IT budgets and investments in a wide range of technologies, including cloud, mobile, big data, and analytics along with core payer administrative, claims processing, and care management solutions. The 66 respondents represent a combination of C-suite executives and senior leaders representing IT and lines of business from small to large health plans. The survey was fielded January 2 30, Findings regarding respondent demographics are presented in the Appendix: Respondent Demographics section in the Learn More section of this Perspective. Note: All numbers in this document may not be exact due to rounding. Situation Overview Payers Continue to Embrace Cloud Technology Nearly half (45%) of the respondents to the IDC Health Insights' 2014 Healthcare Payer IT Investment Survey reported that they were currently using cloud computing. The remainder respondents reported that they are either planning to deploy cloud within the next year or researching options. No respondents reported that they are not using, researching, or evaluating cloud computing. This represents a surge in cloud adoption in 2014 compared with the findings from last year's annual survey; in last year's survey, only 22% of respondents indicated that they used cloud computing, and 38% of respondents reported that they were not using, researching, or evaluating cloud services (see Figure 1). April 2014, IDC Health Insights #HI247809

2 Payers have high expectations when it comes to cloud services and look for business, cost, and technology improvements. Speed to market (83.3%) and IT infrastructure cost reduction (81.7%) are the top 2 benefits of cloud computing cited by healthcare payer executives. These findings are consistent with surveys in prior years. Management is increasingly recognizing that moving to the cloud may not result in reductions in IT staff head count (30%), but that using cloud services will allow management to extend existing IT staff to cover more projects and improve service levels by redeployment (58.3%) and specialization (see Figure 2). FIGURE 1 U.S. Healthcare Payer Cloud Adoption, 2013 and 2014 Q. Has your organization executed any cloud computing strategies? Source: IDC Health Insights' Healthcare Payer IT Investment Survey, IDC Health Insights #HI

3 FIGURE 2 U.S. Healthcare Payer Benefits of Cloud Computing Q. What are your expected benefits to cloud adoption? n = 60 Source: IDC Health Insights' Healthcare Payer IT Investment Survey, 2014 Top Cloud Investment Areas Analytics tops the lists of technology investments as payers grapple with new business and care delivery models. With speed to market as the most frequently mentioned benefit of cloud services, it is not surprising that analytics (57.1%) is also the top application category for cloud solutions. In the constantly changing health reform marketplace, IT departments need to deploy new applications and tools quickly to support the business. Tied for second place are connected health technologies and care and disease management (each 40.8%), with customer relationship management for consumer engagement (38.8%) following closely behind. These application categories are critical to the success of population health management strategies, as payers seek to use analytics to identify their highest risk patients and support and track the progress of the resulting care and disease management programs while driving changes in utilization through member engagement (see Figure 3). Top investment areas in 2013 were consumer portals (71.4%) and provider portals (71.4%). These application categories were ranked lower in priority this year, suggesting that payers have established their portals and are seeking other cloud-based technologies, such as analytics and end-to-end remote health monitoring, to identify members who are good candidates for interventions like care and disease management programs and to track changes in member populations over time IDC Health Insights #HI

4 FIGURE 3 U.S. Payer Cloud Solution Deployment Plans, 2014 Q. For what application categories are you executing cloud solutions in 2014? n = 40 Source: IDC Health Insights' Healthcare Payer IT Investment Survey, 2014 Payers Prefer Private Clouds Over Public Clouds According to IDC's May 2013 Vertical IT and Communications Survey, 26.8% of payer respondents reported that they were using private clouds in production enterprisewide or in business units or departments. Only 8.3% of respondents reported that they were using public cloud options enterprisewide or for select business units or departments (see Figure 4). These findings are consistent with IDC research across the healthcare payer and provider sectors; the healthcare industry has a strong preference for private cloud services when handling sensitive member and patient data, and the benefits and economies of scale of public cloud are not as clear as those seen in other industries. While the primary reasons for using either private or public clouds were the same hardware and software cost savings, lower outside maintenance costs, and decreased pressure on internal IT resources 28.1% of respondents to the same survey cited greater security as the reason for using a private cloud compared with using a public cloud IDC Health Insights #HI

5 FIGURE 4 Current Deployment Status of Private and Public Cloud Computing Q. At what stage is your organization today in the deployment of each of the following initiatives? Source: IDC's Vertical IT and Communications Survey, May 2013 When asked "what security provisions would be required for you to consider moving more of your infrastructure and applications into the cloud," 54.5% of respondents stated a customized service-level agreement (SLA) or other security provisions for the health industry; financial indemnification for all costs associated with breaches, including follow-on legal actions by victims (42.0%); and financial indemnification for direct costs associated with breaches, such as regulatory penalties, fines, and required actions (39.8%) rounded out the top 3 required security provisions. Total cost (67.4%) and industry experience and expertise (65.1%) were the top 2 attributes for infrastructure-as-a-service 2014 IDC Health Insights #HI

6 (IaaS) providers. Furthermore, 59.2% of total respondents indicated that it was important (19.5%) or very important (39.7%) that external cloud vendors providing IaaS offer performance-level assurances through SLAs (see Figures 5 and 6). FIGURE 5 Critical Security Provisions for Moving to Cloud Services Q. What security provisions would be required for you to consider moving more of your infrastructure and applications into the cloud? n = 54 Source: IDC's Vertical IT and Communications Survey, May IDC Health Insights #HI

7 FIGURE 6 Key Attributes for Infrastructure-as-a-Service Providers Q. On a scale of 1 5, where 1 = not very important and 5 = very important, please indicate how important are the following attributes of external cloud vendors providing IaaS (infrastructure as a service). n = 54 Source: IDC's Vertical IT and Communications Survey, May 2013 Future Outlook Most payers (81.2%) reported that they are using external resources for their private or public cloud implementations, while 42% reported that they were using internal resources alone or in combination with external resources (see Figure 7). There is a learning curve associated with supporting cloud operations, and payers are clearly relying on external resources to extend their teams and allow their own resources to acquire skills while redeploying their IT resources to support the move to the cloud. According to IDC Health Insights' 2014 Healthcare Payer IT Investment Survey, respondents reported 2014 IDC Health Insights #HI

8 that payer IT services budgets will increase over the next 12 months as a result of demand for IT skills associated with cloud technologies (71%) compared with more frequently mentioned demand for analytics skills (80.6%). Payers state that over the next five years, they plan to limit cloud deployment to IT activities such as developing and testing of new applications and storage and hosting (27.6%) and in-house private clouds (27.4%). Only 5.9% of payers reported that the majority (at least 50%) of their IT operations will be sourced or performed in a public cloud (see Figure 8). FIGURE 7 Use of Internal and External Resources for Cloud Deployment Q. Are you using internal or in-house resources for your private and public cloud implementations or are you seeking help from an external vendor? n = 54 Source: IDC's Vertical IT and Communications Survey, May IDC Health Insights #HI

9 FIGURE 8 U.S. Healthcare Payer Long-Term Expectations for Cloud Services Q. Which of the following best describes your long-term expectations for cloud services at your organization over the next five years? n = 54 Source: IDC's Vertical IT and Communications Survey, May 2013 Essential Guidance Cloud adoption among U.S. healthcare payers is widespread and growing, with private cloud as the dominant model. As payers look to move new workloads into the cloud to respond quickly to changing business and regulatory requirements, they should consider the following recommendations: Look for cloud providers with healthcare offerings, plus industry experience and expertise, when sourcing cloud services for payer operations. These cloud service providers will be more likely to understand the constraints associated with handling HIPAA-protected data and the unique demands of vertical applications. Require business associate agreements and healthcare-specific SLAs. Best practices for constructing these SLAs should include both compliance with HIPAA rules and service metrics specific to the demands of the application and end users. For many organizations, concerns about security and, more generally, the uncertainty of cloud raise significant risk challenges. Technically, many of the risks can be managed, though not eliminated, with appropriate SLAs IDC Health Insights #HI

10 Ask for financial indemnification for costs associated with breaches such as regulatory penalties, fines, and required actions, as well as follow-on legal actions by victims. Cloud service providers familiar with healthcare will understand the risks and penalties associated with HIPAA breaches, but cloud service providers with less experience in the vertical may require education. It is important that both customers and suppliers have a full understanding of the breach risk and economics before entering into a relationship. Manage security risk, but don't rule cloud out. The majority of healthcare CIOs with experience working with cloud service providers find that the cloud can offer the same or better breach risk profiles compared with on-premise deployment (according to IDC's 2013 CloudTrack Survey). As with on-premise deployments, security issues need to be managed carefully with cloud, but this should not be a deterrent to adopting cloud strategies. Look for cloud providers that offer consulting, training, and implementation services to facilitate the transition to the cloud. While external service providers can be helpful when getting started with cloud and supporting ongoing operations, the on-premise IT staff also needs to understand and develop skills to support and troubleshoot cloud environments. A strong in-house cloud skill set will allow payer organizations options when making the decision to outsourcing or keep clouds on-premise and allow for flexibility to change cloud service providers or bring operations in-house if desired. Expect to pay a premium for healthcare-specific services. The HIPAA Omnibus Rule, published in early 2013 by HHS, clearly spells out the risk-sharing obligations that exist between cloud service providers and customers when it comes to operating as business associates. Payers should be certain that cloud service providers understand this obligation before entering into partnerships and should expect the pricing of healthcare-specific services to reflect the shared risk. Transition to a service-centric organization. When making the move to the cloud, the IT organization will change. Cloud will require different skill sets, but standard services and platforms typically allow staff to retrain and specialize to support the new environment, allowing for additional efficiencies with improved service levels. Set key IT goals that lead to new levels of existing IT services and new services. Cloud should present an opportunity for the IT organization to improve service levels and offer more services to end users with the same staffing levels. To ensure that the organization captures these efficiencies, planning the transition to cloud and setting goals should be part of the process. Continue experimentation and develop best practices related to cloud computing. Each payer IT organization will need to experiment to determine the cloud practices that are best suited to the needs of its staff and end users. The transition in staffing and service roles will take time, and organizations should allow for experimentation as best practices emerge. IDC defines five stages of cloud maturity, and the final stage, optimized, refers to an organization that has standardized policies around the use of cloud, has made cloud a best practice, and has the ability to not only move services to the cloud but also capture efficiencies and benefits that could not be achieved in traditional deployments. Connect cloud to other new technology investments. Cloud environments need to be embraced as an extension of existing on-premise and other new technology investments. Ensure that users can dynamically access internal and external resources via a common self-service portal and service catalog IDC Health Insights #HI

11 Evaluate and document the technical and business risks of specific workloads shifting to cloud. Payers should weigh the benefits and risks of moving specific workloads to cloud. The business impact of cloud is most noticeable for new initiatives as well as for high business value or highly innovative projects, where some level of customization of IT resources is critical and risk sharing creates an environment that fosters innovation. Exploit the capabilities of cloud to create opportunities for business, including new cloudenabled products and services. Optimized cloud implementations will drive business innovation through seamless access to IT resources and allow payer organizations to make informed decisions based on true cost and value with internal and external partners. LEARN MORE Related Research U.S. Healthcare Payer Top Predictions: Focus on Analytics (IDC Health Insights #HI244841, December 2013) Perspective: Healthcare Payer Analytics Investments 2013 and a 2014 Top 5 Preview (IDC Health Insights #HI243429, September 2013) Business Strategy: Health Insurance Exchange Maturity Model for Private Exchanges Achieving Retail Strength Consumer Engagement (IDC Health Insights #HI243339, September 2013) Vendor Assessment: U.S. Healthcare Payer Core Vendor Update The Emergence of Competition on Value (IDC Health Insights #HI242649, August 2013) Perspective: Embracing Innovation Application Trends for Healthcare Payers, (IDC Health Insights #HI241999, July 2013) Business Strategy: Healthcare Payer Consumer Engagement Business Models, Adoption, and Market Update, 2013 (IDC Health Insights #HI242065, July 2013) U.S. Healthcare Payer IT 2013 Top 10 Predictions: Embracing Innovation (IDC Health Insights #HI239436, February 2013) Perspective: Cloud Adoption and Deployment in the Healthcare Payer Market in 2012 (IDC Health Insights #HI237023, September 2012) Appendix: Respondent Demographics Figures 9 and 10 show respondent demographics by health plan size and job title IDC Health Insights #HI

12 FIGURE 9 U.S. Healthcare Annual Payer Survey Respondents by Health Plan Size Q. How large is your health plan organization? Source: IDC Health Insights' Healthcare Payer IT Investment Survey, 2014 FIGURE 10 U.S. Healthcare Annual Payer Survey Respondents by Job Title Q. Which of the following best describes your current title or role? n = 60 Source: IDC Health Insights' Healthcare Payer IT Investment Survey, IDC Health Insights #HI

13 About IDC International Data Corporation (IDC) is the premier global provider of market intelligence, advisory services, and events for the information technology, telecommunications and consumer technology markets. IDC helps IT professionals, business executives, and the investment community make factbased decisions on technology purchases and business strategy. More than 1,100 IDC analysts provide global, regional, and local expertise on technology and industry opportunities and trends in over 110 countries worldwide. For 50 years, IDC has provided strategic insights to help our clients achieve their key business objectives. IDC is a subsidiary of IDG, the world's leading technology media, research, and events company. Global Headquarters 5 Speen Street Framingham, MA USA idc-insights-community.com Copyright Notice Copyright 2014 IDC Health Insights. Reproduction without written permission is completely forbidden. External Publication of IDC Health Insights Information and Data: Any IDC Health Insights information that is to be used in advertising, press releases, or promotional materials requires prior written approval from the appropriate IDC Health Insights Vice President. A draft of the proposed document should accompany any such request. IDC Health Insights reserves the right to deny approval of external usage for any reason.

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