Technology modernization and the alignment of investments with organizational goals, along with picking the right vendor to partner with, are top of mind for payer executives in 2024, according to a Jan. 30 survey published by digital solutions firm HealthEdge.
Thirty percent of the more than 350 executive respondents were from a health plan, 27% were from a BCBS plan, 26% were from a specialty health plan and 17% were from a provider-owned health plan. Twenty-five percent of respondents were from plans with 50,000-100,000 members, and 21% were from plans with less than 50,000 members. Twenty-five percent of respondents were clinical executives and 24% were part of executive leadership at their health plan. Forty-two percent of respondents operate in 6 to 10 states, and 37% operate in 2 to 5 states.
Eight key findings:
1. Investing in modern technology for digital transformation is the top strategy for 62% of payer executives looking to achieve their company's goals in 2024.
2. Executives named the top five challenges currently facing their company: Alignment between IT and business departments, high employee turnover and burnout, business growth, management of costs, and member satisfaction.
3. Executives named the top five most promising strategies to reduce administrative costs: Increased interoperability, increased claims accuracy, additional training for end users, increased auto-adjudication rates, and increased clinical management panel size.
4. When looking for technology vendors, executives prioritize five key things: modern capabilities, easy access to real-time data, ease of business and customer service, ease of setting up and upgrading, and ability to automate and drive efficiency.
5. The biggest challenges to growing membership are the ability to offer a variety of plans (31%), ability to effectively market them (28%), the ability to respond to growth opportunities (28%), and competitors who already dominate the market (13%).
6. When it comes to maintaining regulatory compliance with CMS, payers struggle with a lack of capable of vendor partners (19%), managing fee schedules (19%), a lack of internal experts (16%), a lack of technology that can keep up (16%), a lack of IT staff (14%), and interoperability mandates (14%).
7. When it comes to what negatively impacts a member's satisfaction most, executives said inadequate communication (22%), high costs (20%), surprise/difficult billing (17%), lack of personalization (14%), no self-service (10%), inadequate provider network (10%), and a lack of transparency (7%).
8. When it comes to what negatively impacts relations with providers the most, executives said lack of real-time data access (24%), payment issues (18%), lack of transparency (17%), slow claims processing (16%), ineffective provider data management (15%), and an inability to answer questions (10%).