Managing costs, operational efficiencies top challenges for payers

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In 2021, the pace of change in the healthcare industry picked up dramatically, with the introduction of new regulatory requirements, rising expectations among consumers, new competitive threats and the shift toward value-based payment strategies. This change has resulted in shifting priorities for payers, who now cite managing costs as a top concern.

That's according to a recent HealthEdge survey, which found that among healthy plan leaders, 46% cited managing costs as among their top three challenges. This was followed by driving operational efficiencies (41%). 

These are the first- and second-most cited challenges this year, respectively. In last year's survey they were fourth and fifth.

The survey, administered by PureSpectrum, a brand intelligence platform based in Westlake Village, California, tapped 312 health payer executives between April 26 and May 6.

WHAT'S THE IMPACT?

With managing costs as this year's top issue, respondents believe increasing interoperability (44%) and improving claims accuracy (40%) would help them most effectively reduce administrative costs. 

This, the survey found, would likely result in health plans becoming more digital, revisiting their payment integrity strategies and looking to improve claims accuracy and auto-adjudication rates with more agile, real-time and automated systems.

Health plan leaders' top goals include increasing quality, improving provider relationships, meeting regulatory compliance requirements and increasing member satisfaction. To achieve those goals, respondents said they planned on taking a number of steps, including making significant investments in innovation (53%), aligning the business and IT organization toward common goals (53%), improving engagement strategies (52%) and modernizing technology (51%).

Most priorities remain consistent with the previous year, while the focus area of aligning the business and IT organizations toward common goals moved from last place to second place. This indicates the growing recognition of the important role investing in technology and infrastructure plays in a health plan's ability not only to achieve their business goals but grow and innovate.

THE LARGER TREND

Themes from the survey indicate that health plan leaders are looking for new ways to do more with fewer resources in a digital, real-time manner. Health plans have to be increasingly agile, which comes down to the automation of manual processes and moving to more modern systems, as well as the growing demand for real-time data access to mitigate the costs and disadvantages associated with data lag.

Connecting relevant claims and clinical data is a critical component of member satisfaction, compliance and overall operational efficiency, the survey found.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com