COVID-19 Forces Healthcare Payers to Face Up to Modernization, Member Service Shortcomings—Everest Group

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Everest Group research details how COVID-19 has compelled healthcare payers to future-proof their technology and build more resilient care models.

Everest Group

EVEREST GROUP

COVID-19 has irrevocably disrupted the traditional way of delivering care. Payers are developing strategies to reimagine member satisfaction by addressing challenges around communication, care access, coordination and responsiveness.

COVID-19 acted as a forcing function for healthcare payers to future-proof their technology estate and enable more resilient care models, according to new research from Everest Group. The pandemic pushed healthcare payers to focus on modernization, automation, data and analytics and cloud.

The high-priority IT investments made by payers in 2020 included the following:

  • IT for operational efficiency: With the onset of COVID-19, payers had to face some serious operational challenges such as disruption of member service operations as well as multiple administrative inefficiencies around provider network management, member communication and claims management. As a result, payers are transitioning to intelligent operations built on the pillars of cloud, artificial intelligence, automation and data to support growth, improve the customer experience and increase quality of care.
  • IT for access to care: Telehealth and home care broke ground as a care channel in 2020. The pandemic pushed technology giants, governments and institutions from varied domains to pool their efforts to innovate to help fight the pandemic. As a result, the ecosystem introduced new applications, information guides, consumer wearables and other devices. Payers have heavily invested in this area through strategic partnerships and acquisitions.
  • IT for member engagement: COVID-19 has irrevocably disrupted the traditional way of delivering care. Payers are developing strategies to reimagine member satisfaction by addressing challenges around communication, care access, coordination and responsiveness. They are increasing members’ access to health information, creating next-generation service desktops, launching health applications, and building member engagement platforms.

These findings and more are shared in Everest Group’s Healthcare Payer Enterprise Insights H2 2020 report. This report evaluates payer performance in H2 2020 and focuses on industry- and account-level financial and line-of-business performance, key business and IT investment themes, and the Global Business Services (GBS) landscape.

Additional key findings:

  • Most payers exhibited sustained revenue growth in 2020. At the onset of COVID-19, payers posted strong numbers due to a drop in non-COVID-19 claims. Most of the U.S. payers witnessed a growth in revenue on a sequential basis, attributed to a temporary reduction in operating expenses due to deferred surgeries and procedures as a result of stay-at-home orders across the U.S. However, operating and net income saw a dip in Q3 and Q4 2020, impacted by COVID-19 care costs.
  • The payer market experienced an uptick in the government membership enrollment along with a subsequent decline in commercial business. Large national plans with existing presence in Medicaid or exchange markets saw an increase in enrollees, while others looked to enter/expand into these lines of business through acquisitions and partnerships.
  • Payers’ response mechanism to the pandemic involved significant focus and strategic investments to improve clinical outcomes, increase operational efficiency, reduce cost of care, improve access to care, and enhance member experience.
  • Payers are investing in expanding their value-based care partnerships to enhance healthcare services for their high-growth Medicare Advantage member segment.
  • Mental/behavioral health innovation and technology is gaining significant traction in the healthcare payer industry.

***Download a complimentary abstract of the report here.***

About Everest Group
Everest Group is a research firm focused on strategic IT, business services, engineering services, and sourcing. Our clients include leading global companies, service providers, and investors. Clients use our services to guide their journeys to achieve heightened operational and financial performance, accelerated value delivery, and high-impact business outcomes. Details and in-depth content are available at http://www.everestgrp.com

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Andrea Riffle

Jennifer Fowler
@EverestGroup
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