HealthEdge Survey: Modern Technology Driving Health Plan Strategy

Majority of health plan leaders say digital transformation is their top strategy to accomplish organizational goals this year

BURLINGTON, Mass.--(BUSINESS WIRE)--HealthEdge, a next-generation healthcare SaaS company, today released its annual survey of the healthcare payer market. The survey features insights from over 350 US health plan executives and reveals top-of-mind objectives in 2024.

The survey of US health plan executives working across functions found rising consolidation among payers and providers, 25% of leaders are considering new partnerships or acquisition as a strategy to reinvest cost savings. Other leaders (22%) are considering using these savings to invest in a new geography or line of business.

Today’s health plans continue to grapple with the lingering impacts of the pandemic, including inflation, workforce shortages and a shift toward virtual care options. The majority of health plan leaders (62%) are investing in modern technology for digital transformation as the number-one way to achieve organizational goals in 2024. Modern technology will enable payer leaders to address their top five challenges, which the survey identified as:

1. Alignment between IT and business: Payers need flexible and agile technology, rather than costly and time-consuming solutions, to enable their businesses to expand in this competitive market.
2. High employee turnover/burnout: As more healthcare workers leave their jobs, health plans are deploying technology to eliminate repetitive tasks and staff burnout.
3. Business growth: Executives are turning to strategic planning and agile technology to enable growth amid macroeconomic challenges.
4. Managing costs: In a push to manage costs, health plan leaders are improving the financial accuracy of claims, increasing auto-adjudication rates, increasing interoperability across the healthcare ecosystem and providing additional training for end users of technology solutions.
5. Member satisfaction: Increasing consumer choice and pressure from regulatory agencies — including the Centers for Medicare & Medicaid Services (CMS) doubling the weight of member satisfaction in calculating Star ratings for the 2024 reporting year — have pushed health plans to emphasize member satisfaction. Respondents report that inadequate communication and high costs have the greatest negative impact on members’ satisfaction.

“Achieving deep collaboration between business and technology leaders is essential for payers to compete in today’s market,” said Alan Stein, Chief Product and Strategy Officer at HealthEdge. “Health plans are rethinking their use of technology and prioritizing investment into solutions that propel them toward reaching transformational organizational outcomes, such as new market expansion, member engagement, and regulatory compliance.”

Nearly one-third of health plan leaders stated that providing the variety of plan offerings needed to satisfy member demands is the biggest challenge to acquiring new members, while 28% reported ​​their top barrier is conducting effective marketing outreach to attract and engage new members.

Additionally, respondents indicated that the lack of technology or partners to enable regulatory compliance was their organizations’ biggest challenge to staying compliant with CMS’s frequent changes to quality standards and payment rules.

The full report dives deeper into these findings to help health plan leaders understand the top-of-mind challenges for their peers and how to thrive in today’s market.

About HealthEdge

Innovating a world where healthcare can focus on people, HealthEdge® is driving a digital transformation through a single digital ecosystem that delivers advanced automation and clinical engagement among healthcare payers, providers, and patients. The next-generation healthcare SaaS company provides an integrated ecosystem of advanced solutions for core administration (HealthRules® Payer), payment integrity (HealthEdge Source), care management (GuidingCare®) and member experience (Wellframe) that empower health plans to accelerate business, reduce costs and improve outcomes. Follow HealthEdge on Twitter or LinkedIn.