Health Plan Leaders Try To Keep Up With Changing Industry, Study Finds

Managing costs and finding operational efficiencies topped the list of things that health plan leaders are concerned with, according to a new survey from HealthEdge.

The digital health solutions company surveyed more than 300 health plan officials from a range of payer types, with the goal of providing a better understanding of what is top of mind in the industry.

The result showed an increased priority on cost management and operational efficiencies, with member satisfaction and alignment of IT and business needs tying for third.

Health plan change is picking up speed

“The pace of change has picked up dramatically in the past year, with the introduction of new regulatory requirements, rising expectations among health care consumers, new competitive threats, and the shift toward value-based payment strategies,” the report says.

As with many issues facing companies and business leaders today, the pandemic has played a large role. The report’s authors point to an uptick in claim volumes and rising costs due to delays in care as two pandemic-related problems that companies are dealing with. The tight labor market is also a factor, the report says.

“Operational efficiencies have always been a challenge for health plans, but as workforce shortages continue to plague the market; health plan leaders appear to be looking for new ways to do more with fewer resources,” the authors write.

The report also notes the changing expectations of consumers. “Expectations continue to rise as health consumers’ purchasing drivers are being shaped by their retail experiences with companies like Amazon and Google,” the report says. “With greater access to real-time clinical and operational insights as well as the tools to facilitate meaningful member engagements, care managers are able to reach more members and build stronger member relationships to meet today’s health care consumer expectations.”

One issue the report singles out is the need for access to real-time data. “In keeping with the trend toward modern technology, real-time access to data across payers, lines of business, and departments emerged as a common theme,” the report says. “By equipping users and clinical resources (care managers, nurses, physicians) with greater access to the most up-to-date data, everyone makes better decisions – for the financial health of the business as well as the health and wellbeing of the member. Good data typically equals good business.”

Priorities for leaders

The survey identifies several areas that health plan leaders say are priorities for the future. These include making significant investments in innovation (53%), align business and IT goals (53%), improve engagement strategies (52%), and modernize technology (51%).

Health plan leaders also had concerns about keeping up with an industry in flux; technology and labor shortages were listed as top concerns in both 2021 and 2022. The top concerns included lack of IT staff or resources, outdated technology or infrastructure, interoperability mandates, managing fee schedules, and lack of in-house regulatory experts.

“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,” HealthEdge says in a statement. “Health plans must increasingly be very 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.”


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