An Essential Evolution: How Healthcare Payers Can Adapt, Innovate and Lead

As the healthcare landscape continues to evolve and become more sophisticated, health plans are actively seeking out ways to adapt, innovate, and lead. In our recent webinar, An Essential Evolution, we brought together experts to explore the realm of digital transformation (or modernization), shining light on the critical yet often underestimated health plan business area: Product. Product, and its associated data, is the cornerstone that nearly every health plan business process relies on and aligns with the driving forces of modernization: administrative spend, growth in Medicare Advantage, evolving regulations, and expansion into new markets. For an insider’s guide to the “Underappreciated Data Subject Area: Product”, click here.

Let’s dissect these influential drivers:

Administrative Cost Savings: Health plans face relentless pressure to curtail administrative expenditures, particularly with healthcare expenses projected to rise by 7% next year — due to providers continuing to face workforce shortages and high labor costs.

The Power of Product: Efficient product management solutions, when seamlessly integrated across the enterprise (claims, sales, customer service, etc.) have transformative power over payer administrative expenses. They get it done faster and with greater accuracy, all while optimizing the deployment of resources. By integrating their document generation with product data, one forward-thinking health plan saw an average of $5M in net administrative savings per year.

Growth in the Medicare Advantage Market: Competition in the Medicare Advantage market is at an all-time high and the supplemental benefit packages are becoming increasingly more important in attracting and retaining members.

The Power of Product: Efficient product management solutions not only ease PBP processes (reducing time, expense, and sheer frustration) but also equip health plans with operational efficiencies that enable innovation. This innovation extends to the design of customized supplemental benefit packages that seniors want, without straining existing resources and systems.

Evolving Regulatory Landscape: The adage “the only constant is change” is especially true with regulations in health insurance. Adapting to legislative updates and shifts in healthcare policy is an ingrained practice among payers. But today, they also contend with evolving industry standards coupled with the exponential growth in their product portfolios necessary to meet market demands and maintain competitiveness. This expansion has added layers of complexity and heightened difficulty to ensuring regulatory compliance.

The Power of Product: Efficient product data management solutions provide a single source of truth, bulk update capabilities, automation, and efficient processes. This allows health plans the ability to make changes easily and then automatically apply the changes across multiple products. They gain speed with automation, instilling confidence in data accuracy.

Expansion into New Markets: Expanding into new markets brings both opportunities and challenges to health plans. Before making the leap, they need to determine how the increase in volume of benefits, network tiers, plans to file, state regulations to comply with (if expanding into new states), and more documents to generate will impact their bottom line.

The Power of Product: Efficient product data management and enterprise integration of that product data can drastically lessen the administrative blow that comes along with market expansion. Due to automation, smart workflows, and a single source of truth, expansion is possible without the need for substantial staff augmentation.

Although often underestimated, effective product management is the gateway to innovation. It empowers health plans to reduce costs and improve operational efficiency while navigating the complexities of the evolving healthcare industry and securing a pathway to sustainable growth.

To view the full webinar, click here.

For an insider’s guide to the “Underappreciated Data Subject Area: Product”, click here.