Nearly 500 health plan leaders consider security, modern technology, and product expansions as the most important.

BURLINGTON, Mass.: HealthEdge®, a leader in healthcare technology solutions, has released its annual survey of the healthcare payer market revealing the top priorities, investments, and challenges for the coming year. The survey, of more than 450 executives, found that health plans are prioritizing enhancements to integrated solutions or services (62%), digital transformation or technology upgrades (49%), and new product lines (47%).

“The annual survey offers valuable insights into the challenges and opportunities for health plans,” said Alan Stein, Chief Product and Strategy Officer at HealthEdge. “Modernizing technology and enhancing interoperability to cut redundant health plan administrative costs and boost member experience is essential. HealthEdge is committed to aiding health plans in this transformation, keeping member needs front and center.”

Artificial intelligence is gaining traction among health plans, with 15% of respondents prioritizing investments in AI technologies. This trend reflects a broader commitment to leveraging AI to enhance various aspects of healthcare. Health plans are also investing in digital health and experience (19%) and care delivery and enablement (16%). Other key findings include:

• Security is a top priority for executives: When considering technology and data science transformation, 46% of respondents listed security as their highest priority, followed by technology modernization (26%) and pilot-gen AI enterprise use cases (15%).
• Staying compliant with frequent regulatory changes: Only one-third of respondents feel they are ready for upcoming regulatory changes. Payers are the most prepared for the Transparency in Coverage and No Surprises Act and least prepared for Payer-to-Payer Data Exchange. The top three challenges to maintaining Centers for Medicare and Medicaid Services compliance are managing fee schedules (55%), the lack of technology partners to ensure regulatory compliance (54%), and the lack of IT staff or resources to adapt to regulatory changes (50%).
• Provider engagement and satisfaction: 60% identify delays in claims processing as the cause of this challenge. Limited access to real-time data and information sharing (45%) and a lack of transparency (43%) are also barriers to effective payer-provider relationships. To address these challenges and improve member outcomes, payers are investing in provider network management, payment integrity, and increased provider collaboration and value-based care contracting.
• Payers are committed to providing a personalized experience for members: Health equity (59%), self-service tools (52%), and data transparency (51%) are key member engagement priorities for plans. Insurers are looking to improve member satisfaction through member portals, member-facing mobile apps, and enhancing or expanding member service centers.
• Health insurers are working to expand care access: 74% of respondents are planning to continue using telehealth services, especially for mental and behavioral health, in the coming year.

“In light of recent disruptive cyberattacks, health plans are working harder than ever to fortify member data from threat actors,” said Jeannine Gaudreau, Chief Information Security Officer at HealthEdge. “HealthEdge is committed to building security into the foundation of its products and ensuring that data is handled responsibly and confidentially.”

The full report includes a comprehensive roadmap for health plan executives to adapt to regulatory changes, enhance member engagement, and improve operational efficiency. Through partnerships with technology vendors, payers can ensure they have the right tools to navigate the complexities of the healthcare industry and drive long-term growth.

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. Learn more at HealthEdge.com and follow us on LinkedIn.

Fonte: Business Wire