Managing costs and increasing operational efficiency are the top challenges for health plan leaders today, HealthEdge research posted on tuesday found.
The annual survey received responses from 312 payer executives. It took place between April 26 and May 6.
When asked what their biggest challenges are today, 46% say managing costs and 41% say driving operational efficiency. This could be due to the increase in claims volume from the Covid-19 pandemic, rising costs from people delaying care and the use of outdated systems, according to the study.
“Operational efficiency has 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 report said. “And it comes down to building a solid digital foundation on which payers can eliminate repetitive manual processes and provide greater access to real-time data that is possible with modern systems.”
Many respondents also said that member satisfaction is a challenge as consumers take a greater role in the decision-making process about their health benefits.
“Expectations continue to rise as healthcare consumers’ purchase drivers are shaped by their retail experiences with companies such as Amazon and Google,” the study said. “With greater access to real-time clinical and operational insights, as well as the tools to facilitate meaningful member engagements, care managers can reach more members and build stronger relationships with members to respond to today’s consumer expectations in healthcare.”
To combat rising administrative costs, 44% of respondents said increasing interoperability and 40% said improving the accuracy of claims would help.
When asked about claims accuracy, only 26% said more than 80% of their claims were paid right the first time. When they are not paid properly, the average cost of a claim increases, the report said.
Respondents’ primary goals were to improve quality, improve supplier relationships, meet regulatory compliance requirements, and increase member satisfaction. To achieve this, 53% say they will invest in innovation, 53% say they will align business and IT organizations toward common goals, 52% say they will improve engagement strategies, and 51% say they will modernize technology.
Most of these steps to achieve the goals are similar to last year’s, although business alignment with IT organizations has taken priority. This step ranked last last year and jumped to No. 2 in this year’s six-step survey.
“This demonstrates the growing recognition of the important role technology plays in a health plan’s ability to achieve its business goals,” the report said.
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