West Monroe, a business and technology consulting firm, in collaboration with Healthcare Dive, today published their latest research report, “What Payers Are Seeking with their Digital Investments." The findings shed light on the critical need for payer organizations to shift their mindsets and rethink their approach to digital investments.
The research conducted by West Monroe with studioID surveyed 150 executives from healthcare payer organizations to gain insights into the current state of the industry. The research reveals as healthcare organizations confront shrinking margins, persistent workforce shortages and upcoming regulatory shifts, payers must find innovative strategies for increasing efficiency without shortchanging member experience --- leading to investments in a spectrum of digital capabilities spanning claims automation, member enrollment, payments, and analytics.
Key highlights from the research include:
- Organizations are re-thinking traditional project and portfolio prioritization processes and are bringing a product mindset to the forefront.
- As more digital assets emerge, payers who lack a strategy around point solution integration face headwinds with adoption and ROI—particularly when it comes to the member experience.
- When done correctly, digital evolution enables better outcomes and accelerated alternative reimbursement capabilities.
"In today's evolving healthcare landscape, our research underscores the imperative for payer organizations to realign their digital investments to meet the dual challenges of containing costs and enhancing member experiences," said Paul Horner, Payer Industry Lead at West Monroe. "By rethinking traditional prioritization processes and embracing a comprehensive approach to digital evolution, payers can unlock opportunities for better outcomes and accelerated adaptation to alternative reimbursement models."
Strategic investments in digital products and tech
Decision-makers within payer organizations prioritize data analytics and cybersecurity, yet often overlook change management and organizational transformation. While 49% of respondents focus on each of these areas, only 23% list them among their top investment priorities.
Data integration plays a pivotal role in providing seamless experiences for stakeholders. This involves rationalizing architectures and adopting a product mindset to drive transformation.
Integration will boost member experience
The survey uncovers widespread challenges in integrating digital marketing platforms and member acquisition processes among payer organizations. Many struggle to personalize digital campaigns and implement digital self-service solutions due to complex business processes. A significant 43% of respondents cite excessive complexity inhibiting progress in this area.
Setting the right foundation is crucial to achieve cost savings and improve relationships across all constituents.
Preparing for the transition to value-based care
As the healthcare landscape shifts towards integrated and value-based care models, payer organizations are investing in technologies to streamline operational processes. Nearly half of the respondents report upgrading care management systems in the past year, with a vast majority now able to automatically approve prior authorizations.
Successfully implementing digital capabilities is increasingly crucial amidst competing pressures in the healthcare industry. Payers must effectively prioritize initiatives to ensure seamless experiences for members, fostering long-term, high-value relationships.
More detailed findings are available in the report, “What Payers Are Seeking with their Digital Investments.”
Survey Methodology
The online survey polled 150 executives in healthcare payer organizations, comprising 60% from private health insurance plans or integrated care delivery networks, and 40% from commercial payer organizations, third-party administrator organizations, or Medicare/Medicaid secondary payer organizations. All participants held Director-level roles or above, with 21% in the C-suite. Conducted in Q4 of 2023, the survey used various question formats to gauge attitudes towards digitizing office functions. Most participants (67%) work within organizations serving over 500,000 members, with 43% employed by organizations serving one million members or more.
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About West Monroe
West Monroe is a digital services firm that was born in technology but built for business—partnering with companies in transformative industries to deliver quantifiable financial value. We believe that digital is a mindset—not a project, a team, or a destination—and it’s something that companies become, not something they do. That’s why we work in diverse, multidisciplinary teams that blend management consulting, digital design, and product engineering to move companies from traditional ways of working to digital operating models—and create experiences that transcend the digital and physical worlds. Connected by the five values that drive our culture, our 2,000 employees work collaboratively across the firm with the belief that our clients’ success is our success. Visit WestMonroe.com to learn more.