Managing Costs, Operational Efficiencies are Biggest Challenges Facing Payers

A survey of over 300 payer executives reveals what is keeping the industry leaders up at night.

The pace of change for payers has picked up significantly in the past year, causing executives in the industry to rethink their top challenges, according to a survey from HealthEdge.

Based on the answers of 312 respondents from a wide range of payer types, managing costs and operational efficiencies are now the priorities for health plans today. Those challenges ranked fourth and fifth, respectively, in the previous annual survey for 2021. The change, the survey states, can be attributed to an increase in claims volume after the COVID-19 pandemic, rising costs due to delays in care, and outdated administrative systems.

Conducted by brand intelligence platform PureSpectrum from April to May, the survey revealed common themes among payers, including "the move to modern systems to support digital transformations, the growing demand for real-time data access, and anticipated benefits of greater interoperability to help overcome the growing complexities and challenges of the health insurance industry."

Among the respondents, 46% cited managing costs as one of their top three challenges, while increasing interoperability (44%) and improving claims accuracy (40%) were the most popular answers for addressing the issue.

With executives relaying that claims are often not paid accurately the first time and that the cost per claim has increased, the survey notes that there is a heightened focus on advancing automation solutions that will cause health plans to revisit their payment integrity strategies.

Meanwhile, 41% of payer executives chose operational efficiencies as one of their top three challenges. The workforce shortage has forced payers to look for new ways to do more with fewer resources, the survey states, and that includes optimizing processes and increasing access to real-time data.

Member satisfaction and alignment of IT and business needs tied for third place for biggest challenges among the respondents, which was consistent with the previous year's survey.

Looking ahead, payer executives said they are aiming to increase quality, improve provider relationships, meet regulatory compliance requirements, and increase member satisfaction.

To tackle those goals, 53% of respondents plan to make significant investments in innovation, 53% plan to align the business and IT organizations towards common goals, 52% plan to improve engagement strategies, and 51% plan to modernize technology.

Though most of the organizational priorities remained similar to last year's survey, aligning the business and IT organizations towards common goals jumped from last to second place this year. The drastic shift is indicative of health plans' growing understanding of just how much technology plays a role in their business goals, the survey concluded.