New survey assesses the biggest hurdles, goals for health plans amid a rapidly changing landscape

A dramatic pickup in the pace of change for payers in the last year has created new priorities for health plan leaders, a new survey has found. 

The survey, conducted by payment integrity solution HealthEdge, reached more than 300 health plan leaders. Common themes, per a report of the survey results, included the move to newer systems amid a digital transformation, rising demand for real-time data access and the promise of interoperability. 

Some of the biggest threats facing health plans are new regulations, growing consumer expectations, competition and the transition to value-based payment strategies. The top two challenges are managing costs and driving operational efficiencies, which were lower on the list of priorities just last year. Tied in third place are member satisfaction and alignment of IT and business needs. 

There are several drivers of these hurdles. Post-pandemic, there are notably more claims. Long delays in care have also led to rising costs, and outdated systems have required significant investment to keep up with demand. Having a solid digital baseline can help payers eliminate manual, repetitive processes, the report suggested. Payers also believe increasing interoperability and improving claims accuracy helps alleviate administrative costs. 

Less than a third of respondents said the vast majority of their claims were paid accurately the first time around. When claims are not paid accurately, the average cost per claim goes up; this year, that cost rose for a greater portion of respondents compared to last year. “These results indicate the heightened focus on managing costs through advanced automation solutions found in modern systems will likely result in health plans revisiting their payment integrity strategies,” the report noted. 

Meanwhile, when it comes to consumers, expectations are rising amid booming retail experiences offered by tech players like Amazon and Google. By leveraging similar real-time data, care managers can build stronger relationships with their consumers, the report suggested. 

Nearly a quarter of respondents said their technology is not able to keep pace with new Centers for Medicare & Medicaid Services standards and rules. When respondents were asked what the most important capabilities of a tech vendor are to help move to modern technologies, they indicated customer service, modern features, ease of configuration, security and scalability. However, priorities differed across different titles. A CEO preferred modern technology and security, while chief information officers and chief technology officers also preferred scalability. General managers favored quick time on return on investment, and directors preferred customer service. 

When asked what they would do with the resources saved from reducing costs and increasing efficiencies, the biggest portion of respondents said they would invest in a new region or line of business, consider new partnerships or acquisitions and re-leverage resources for innovation.

Among the top goals for plans are increasing quality, improving provider relationships, meeting regulatory requirements and increasing member satisfaction. To that end, more than half of respondents plan to invest in innovation, align business and IT goals, improve engagement strategies and modernize technology. 

“Despite the chaos and challenges posed to health plans today, growth is possible, particularly today for those health plans on modern systems,” the report concluded. In fact, by some estimates, growth is expected to continue.