What it is advisable to know:

– HealthEdge, a supplier of healthcare expertise options, has launched its annual healthcare payer market analysis, highlighting key priorities, investments and challenges for the yr forward.

– The research, which gathered insights from greater than 450 healthcare executives, highlights the concentrate on built-in options, digital transformation and synthetic intelligence (AI).

High priorities for 2025

Well being plans prioritize enhancements to built-in options or providers (62%), digital transformation or expertise upgrades (49%), and new product traces (47%). This alerts a powerful concentrate on modernizing expertise and streamlining operations to enhance effectivity and member expertise.

AI is gaining traction

AI is gaining momentum within the payer market, with 15% of respondents prioritizing investments in AI applied sciences. This displays a rising recognition of AI's potential to enhance varied elements of healthcare, from claims processing and danger evaluation to member engagement and care supply.

Key findings and challenges

The HealthEdge survey additionally recognized a number of key challenges and priorities for well being plans:

• Safety: Safety stays a prime precedence for executives, with 46% citing it as their prime precedence when contemplating expertise and knowledge science transformation.
• Regulatory Compliance: Solely a 3rd of respondents really feel ready for upcoming regulatory adjustments, highlighting the necessity for higher expertise options and assets to successfully handle compliance.
• Service supplier involvement: Delays in claims processing, restricted entry to real-time knowledge, and an absence of transparency are recognized as obstacles to efficient payer-provider relationships.
• Member involvement: Well being fairness, self-service instruments and knowledge transparency are key priorities for bettering member engagement and satisfaction.
• Telehealth: 74% of respondents plan to proceed utilizing telehealth providers, particularly for psychological and behavioral well being.

Investing sooner or later

To handle these challenges and enhance member outcomes, well being plans are investing in a number of areas, together with:

• Digital well being and expertise
• Care provision and involvement
• Supplier community administration
• Cost integrity
• Improved collaboration between healthcare suppliers and value-based healthcare contracts
• Member portals and cellular apps

“In gentle of latest disruptive cyberattacks, well being plans are working tougher than ever to strengthen risk actor member knowledge,” stated Jeannine Gaudreau, Chief Data Safety Officer at HealthEdge. “HealthEdge is dedicated to constructing safety into the muse of its merchandise and making certain knowledge is dealt with responsibly and confidentially.”

For extra details about the report, click on right here.