Technology a central factor among interrelated challenges

THE MOST SIGNIFICANT pressures facing payers evolve constantly, though they rarely change radically from year to year. While payers strive to lower administrative costs and improve efficiencies, manage healthcare costs and grow the business, recent years have seen substantial change in how they address these issues.

Managing administrative costs and improving operational efficiencies are constant issues for all health plans, and leading payers on the path to high performance approach the issue in multiple ways, including:

HEALTHCARE COSTS AND CARE MANAGEMENT

Cost inflation owes its continued existence to the cost and use of pharmaceuticals, increasing numbers of medical interventions for all types of care, regulations and benefits mandates and widespread variations in medical practice, among other issues. Additionally, new technology, such as implantable cardiac defibrillators and other types of implants, is expensive, as are genomic testing and specialty pharmacy treatments for common conditions such as rheumatoid arthritis and cancer-not to mention rare but expensive conditions such as Gaucher disease. To manage these growing costs, leading payers are instituting:

GROWTH CHALLENGES

Revenue growth will be increasingly difficult, as the commercial insurable market shrinks and costs shift away from premiums. But leading payers are focusing aggressively on intelligent growth, making carefully calibrated strategic decisions based on their capabilities and goals in: