300 payer execs on top challenges, opportunities facing insurance industry

As the health insurance industry continues to undergo major change in 2022, payer executives are looking to reduce costs and improve efficiencies through more innovation and alignment with IT services, according to an Aug. 9 survey from digital solutions firm HealthEdge.

The survey was administered by PureSpectrum from April to May and includes responses from 312 payer executives from across the country.

Seven key takeaways:

  1. When asked the top challenges facing their organization, executives said the top two were cost management and operational efficiency. Member satisfaction and alignment between IT and the organization tied for the third biggest challenge.

  2. Respondents said the top strategies to reduce administrative costs are increasing interoperability across the health plan, increasing the financial accuracy of claims and increasing auto-adjudication rates.

  3. Respondents were asked the reasons for why they need real-time data. The top answers were reacting to new regulatory changes, care delivery provisions and payment rules; transparency around reporting with key company stakeholders; and analytics and business intelligence.

  4. The biggest challenges to staying compliant with new regulations are a lack of IT staff or resources, technology that is not proficient and interoperability mandates.

  5. With interoperability specifically, respondents said the biggest challenges around workflow and communications were real-time data-sharing, modern security measures and CMS compliance.

  6. If costs are reduced and efficiency increases, respondents said they would be most likely to reinvest those resources in new markets or new lines, would consider new partnerships or acquisitions and would allocate more to innovation.

  7. To achieve their business goals, executives said their top strategies looking forward are investing more in innovation, aligning the business and IT, and improving engagement strategies.

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