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Managing costs and driving operational efficiency are top challenges for health plan leaders today, HealthEdge Survey Published on Tuesday.
The annual survey received responses from 312 paying executives. It took place between April 26 and May 6.
When asked what their biggest challenges are today, 46% said administrative costs and 41% said driving operational inefficiencies. The reason for this could be the increase in claim rates due to the Covid-19 pandemic, increased costs due to people delaying care and the use of outdated systems, the study found.
“Operational efficiency has always been a challenge for health plans, but as workforce shortages continue to complicate the market, health plan leaders are looking for new ways to do more with fewer resources,” the report said. And that’s building a strong digital foundation where payers can eliminate repetitive, manual processes and make real-time data more accessible with modern systems.
Many respondents said that member satisfaction is a challenge because consumers play an important role in the decision-making process for their health benefits.
“Healthcare consumers’ purchase drivers are increasingly shaped by their retail experiences with companies like Amazon and Google,” the study says. “With more real-time clinical and operational insights, as well as tools to facilitate meaningful member engagement, care managers can reach more members and build stronger member relationships to meet the expectations of today’s healthcare consumers.”
To combat rising administrative costs, 44% of respondents said increased interoperability and 40% said it would help improve claims accuracy.
When asked about claims accuracy, only 26% said more than 80% of their claims were paid correctly the first time. If they are not paid correctly, the average cost of the claim increases, the report said.
Respondents’ primary goals are to increase quality, improve supplier relationships, meet regulatory requirements, and increase member satisfaction. To achieve this, 53% said they will invest in innovation, 53% will align business and IT organizations towards common goals, 52% will improve engagement strategies and 51% will update technology.
Many of the steps to achieve these goals are the same as last year, although aligning business with IT organizations remains a priority. That move was last year’s last year, and in this year’s survey it jumped to No. 2 out of six spots.
“This demonstrates the growing importance of technology in helping health plans achieve their business goals,” the report said.
Photo: Feodora Chiosea, Getty Images
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