Sun. Jan 29th, 2023

Managing costs and driving operational efficiencies are the top challenges for health plan leaders today, a HealthEdge survey published Tuesday found.

The annual survey received responses from 312 payer executives. It was conducted between April 26 and May 6.

When asked what their biggest difficulties are today, 46% said managing costs and 41% said driving operational efficiencies. The reason for this could be increasing claims volumes from the Covid-19 pandemic, rising costs from people delaying care and the use of outdated systems, according to the survey.

“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 report stated. “And that comes down to building a solid digital foundation on which payers can eliminate repetitive, manual processes and enable greater access to real-time data that is possible with modern systems.”

Many respondents also said member satisfaction is a challenge as consumers take a bigger role in the decision-making process of their health benefits.

“Expectations continue to rise as health consumers’ purchasing drivers are being shaped by their retail experiences with companies like Amazon and Google,” the survey said. “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 healthcare consumer expectations.”

To combat rising administrative costs, 44% of respondents said increasing 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. When they aren’t paid correctly, the average cost per claim increases, the report said.

Respondents’ top goals are enhancing quality, improving provider relationships, meeting regulatory compliance requirements and increasing member satisfaction. To achieve this, 53% said they will invest in innovation, 53% said they will align the business and IT organizations toward common goals, 52% said they will improve engagement strategies and 51% said they will modernize technology.

Most of these steps to achieving goals are similar to last year’s, though aligning business with IT organizations has gained in priority. This step was in last place last year and jumped to No. 2 in this year’s survey out of six steps.

“This indicates the growing recognition of the important role technology plays in the ability of a health plan to achieve their business goals,” the report said.

Photo: Feodora Chiosea, Getty Images

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