Technology driving health plan strategy
By Jeff Lagasse–Sixty-two percent of health plan leaders are investing in technology for digital transformation as the number-one way to achieve organizational goals in 2024, a new survey from healthcare SaaS company HealthEdge, a software provider for payers, has found.
The survey of U.S. health plan executives working across functions found rising consolidation among payers and providers. Twenty-five percent of leaders are considering new partnerships or acquisition as a strategy to reinvest cost savings. About 22% of leaders are considering using these savings to invest in a new geography or line of business.
Health plans are continuing to grapple with the lingering impacts of the pandemic, including inflation, workforce shortages and a shift toward virtual care options. The majority of health plan leaders (62%) are investing in technology for digital transformation as the primary way to achieve organizational goals in 2024.
WHAT’S THE IMPACT
The survey identified a number of challenges that can potentially be addressed via modern technology.
One is alignment between IT and business. The survey authors determined that payers need flexible and agile technology, rather than costly and time-consuming solutions, to enable their businesses to expand in a competitive market.
Employee turnover and burnout can also be addressed through technological means. As more healthcare workers leave their jobs, health plans are deploying technology to eliminate repetitive tasks and low morale, results showed.
Executives are turning to strategic planning and agile technology to enable business growth amid macroeconomic challenges, and in a push to manage costs, health plan leaders are improving the financial accuracy of claims, increasing auto-adjudication rates, increasing interoperability across the healthcare ecosystem and providing additional training for end users of technology solutions.
A big challenge that can be addressed technologically is member satisfaction. Increasing consumer choice and pressure from regulatory agencies – including the Centers for Medicare and Medicaid Services doubling the weight of member satisfaction in calculating Star Ratings for the 2024 reporting year – have pushed health plans to emphasize member satisfaction, the survey found. Respondents said inadequate communication and high costs have the greatest negative impact on members’ satisfaction.
THE LARGER TREND
Nearly one-third of health plan leaders said providing the variety of plan offerings needed to satisfy member demands is the biggest challenge to acquiring new members, while 28% reported their top barrier is conducting effective marketing outreach to attract and engage new members.
Respondents also said the lack of technology or partners to enable regulatory compliance was their organization’s biggest challenge to staying compliant with CMS’s frequent changes to quality standards and payment rules.
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