HealthEdge Survey Highlights Growth Opportunities and Challenges for Health Plan Leaders

Over 300 health payer executives share insights on challenges, growth opportunities and future goals

BURLINGTON, Mass.--(BUSINESS WIRE)--HealthEdge, a next-generation healthcare SaaS company that provides a digital foundation for healthcare payers, today released results of its annual Voice of the Market: 2022 Digital Transformation Survey. The survey reflects the opinions of over 300 respondents from a wide range of payer types, with the purpose to help health plan leaders better understand what is top of mind among their peers and what health plans are doing to keep up with today’s highly dynamic and challenging market and regulatory environment.

In 2021, the pace of change picked up dramatically, with the introduction of new regulatory requirements, rising expectations among healthcare consumers, new competitive threats, and the shift toward value-based payment strategies. When survey respondents were asked to report the top three challenges their organizations face today, managing costs (46%) and driving operational efficiencies (41%) made the top of the list this year – jumping up dramatically from their fourth and fifth positions last year.

With managing costs as this year’s top issue, respondents believe increasing interoperability (44%) and improving claims accuracy (40%) would help them most effectively reduce administrative costs. This will likely result in health plans becoming more digital, revisiting their payment integrity strategies and looking to improve claims accuracy and auto-adjudication rates with more agile, real-time, and automated systems like HealthEdge’s payment integrity solution, Source, which will ultimately ensure more claims are processed accurately the first time, thus bringing down the average cost per claim.

Health plan leaders’ top goals include increasing quality, improving provider relationships, meeting regulatory compliance requirements, and increasing member satisfaction. To achieve these goals, respondents plan to take the following steps:

• Make significant investments in innovation — 53%
• Align the business and IT organization toward common goals — 53%
• Improve engagement strategies — 52%
• Modernize technology — 51%

Most priorities remain consistent with the previous year, while the focus area of aligning the business and IT organizations toward common goals moved from last place to second place. This indicates the growing recognition of the important role investing in technology and infrastructure plays in a health plan’s ability to not only achieve their business goals but grow and innovate.

Themes from the survey indicate that health plan leaders are looking for new ways to do more with fewer resources in a digital, real-time manner. Health plans must increasingly be very agile, which comes down to the automation of manual processes and moving to more modern systems, as well as the growing demand for real-time data access to mitigate the costs and disadvantages associated with data lag. Connecting relevant claims and clinical data is a critical component of member satisfaction, compliance, and overall operational efficiency.

The survey, administered by PureSpectrum, the brand intelligence platform based in Westlake Village, California, tapped 312 health payor executives between April 26 and May 6, 2022. Full survey results can be downloaded on the HealthEdge website.

About HealthEdge

HealthEdge® strives to innovate a world where healthcare can focus on people, advancing a digital revolution in healthcare through transaction automation and enabling real-time business and clinical engagement among payers, providers and members. HealthEdge pursues this mission through the delivery of the HealthEdge Digital Platform, consisting of the health insurance industry’s leading cloud-based SaaS applications for core administration (HealthRules® Payor), payment integrity (Source), care management (GuidingCare®), and digital health management and consumer engagement (Wellframe). Offered individually and as an integrated suite, HealthEdge Digital Platform applications provide modern, disruptive healthcare IT solutions that enable health insurers to leverage new business models, improve outcomes, drastically reduce administrative costs, and connect key stakeholders in the healthcare delivery cycle. Follow HealthEdge on Twitter or LinkedIn.