Setting a course for the future

To meet the challenges of the post-pandemic world, we recommend that payers address the following imperatives, adapting these to their business vision, local market conditions and financial strengths.

1

Take out costs. Payers can achieve greater operational efficiencies by consolidating and standardizing on clinical and non-clinical applications (such as revenue cycle management) and migrating these to cloud-based platforms. With the average cost of a manual transaction at almost $7, according to the CAQH Index, the industry could save $16.3 billion annually by converting common administrative transactions to digital.

2

Accelerate the pace of digital initiatives. Digital healthcare momentum is growing, fueled by shifts in consumer behavior, the easing of regulations and adoption of powerful new technologies. Over half of payers expect the pandemic to accelerate the destruction of many non-digital businesses that don’t keep pace.

3

Update skills to reflect the digital future. The automation of processes and the introduction of new roles (such as “bot masters”) require an updated skill set. Payers must think hard about how their staff will intersect with and use robots in their organization. New evaluation metrics such as “robotics quotient,” which scores employees’ ability to work effectively with robots, should be explored to help ease the change management challenges introduced by automation and AI.

4

Improve payer and provider collaboration. Payers and providers should invest in new models to drive system value to reduce costs and improve care. Opportunities exist to jointly use AI, analytics and social determinants data to identify patients and at-risk populations in need of specific care management services.