Reducing the total cost of care is a challenging but key affordability lever. Health plans are investing in analytics to better understand cost drivers in complex care, care gaps, medical cost management, specialty Rx, digital technology and SDOH.
Cultivating provider relations
Improving provider/payer communication by removing points of friction in clinical and administration processes is a key driver of success in the health system. Strategies to reduce provider burden while increasing transparency enable more time to focus on patients.
Driving growth at scale
Payers are focused on growth and entry into new lines of business including Medicare Advantage, ACA and Medicaid. They’re also looking at developing new plan and network designs. Successful growth requires effective risk management and strong performance on quality outcomes.
To drive systemic change, SDOH initiatives have taken on greater importance. Increased financial pressure, food insecurity and housing challenges have been worsened by COVID-19. Virtual care strategies focus on meeting members where they are.