Managing costs and improving operational efficiency are the biggest challenges facing health plan leaders today, HealthEdge polls The findings were published on Tuesday.
The annual survey received responses from 312 payer executives. It runs from April 26th to May 6th.
When asked what their biggest challenge is today, 46% said managing costs and 41% said improving operational efficiency. This could be due to increased claims due to the Covid-19 pandemic, people delaying care and rising costs due to outdated systems, according to the survey.
“Operational efficiency has always been a challenge for health plans, but as labor shortages continue to plague the market, health plan leaders appear to be finding new ways to do more with less,” the report said. “It comes down to building a solid digital foundation on which payers can eliminate repetitive manual processes and have better access to real-time data through modern systems.”
Many respondents also said member satisfaction is a challenge, as consumers play a larger role in the decision-making process for their health benefits.
“Expectations continue to rise as healthy consumers’ purchasing drivers are shaped by their retail experience with companies like Amazon and Google,” the survey said. “Through greater access to real-time clinical and operational insights and the promotion of meaningful memberships A tool for engagement, care managers are able to reach more members and build stronger member relationships to meet the expectations of today’s healthcare consumers.”
In response to rising administrative costs, 44% of respondents said improving interoperability and 40% said improving claims accuracy would help.
When asked about claims accuracy, only 26% said more than 80% of their claims were paid accurately the first time. If not paid correctly, the average cost per claim increases, the report said.
Respondents’ top goals were to improve quality, improve supplier relationships, meet regulatory compliance requirements and increase member satisfaction. To achieve this, 53% of respondents said they would invest in innovation, 53% said they would move business and IT organizations toward a common goal, and 52% said they would improve engagement strategy, with 51% of respondents saying they will modernize their technology.
Most of the steps to get there are similar to last year, but aligning the business with the IT organization has become a priority. This step came last last year and jumped to second place in this year’s six-step survey.
“This demonstrates a growing recognition of the important role technology plays in a health plan’s ability to achieve its business goals,” the report said.
Photo: Feodora Chiosea, Getty Images
