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2020 Recap: Key Factors Impacting Payers


With shifting business and consumer priorities and evolving regulatory mandates, the healthcare industry experienced massive disruption this year. Here are a few of the key factors impacting health plans in 2020.

Delays in Care Impact the Entire Healthcare Ecosystem

In-person appointments and emergency room visits decreased dramatically this year. Health Affairs projected a loss of nearly $68,000 in fee-for-service revenue per physician for 2020 and an estimated $15 billion in losses to primary care practices across the country over the calendar year.

One silver lining this year is the industry’s adoption of telehealth. While there are declines in in-person visits, providers have reported that telehealth visits have increased 50 to 175 times during the pandemic. Payers should seize this opportunity to keep up with consumer demand for this new way to receive care.

The delays in preventative and elective procedures and the associated revenue further expose fee-for-service’s flaws, highlighting the need to adopt value-based reimbursement and new care delivery models. To remain competitive, insurers require flexibility to design benefit offerings that meet their members’ needs and support their providers.

Prioritizing Consumer Satisfaction

Changes in care delivery this year amplified the shifting demands of health plan consumers. Health plans continue to launch digital transformations to compete for members who want more convenient, transparent, affordable, and personalized services. In fact, in a survey conducted by independent brand intelligence research company Upwave, cited 28 percent of health plan IT leaders say perfecting the consumer digital experience is their top business imperative today. Providing personalization and user-friendly digital tools to all healthcare stakeholders will drive enhanced quality, lower operational and healthcare costs, and improve member satisfaction.

Keeping Information Secure Remains Top of Mind For Health Plans

With new technology comes an increased focus on security. Forty-three percent of IT leaders say keeping information secure remains their number one concern with their core administrative system, as a data breach costs health plans $6.45 million on average. In 2020, many health plans’ IT teams moved to a completely remote work environment, highlighting the need for improved security protocols and policies.

Certifications like SOC2 Type2 and HITRUST prove that a health plan has achieved standards that safeguard company and customer information. However, these certifications require significant time and money. Building HITRUST to protect claims information and member data is an investment that many smaller health plans cannot make independently. Partnering with next-generation technology solutions that prioritize security is crucial to ensure sensitive data stays protected.

What’s Next? 

The innovative ideas and strategic shifts health plans made this year opened the door for endless possibilities in 2021.

We are on a mission to revolutionize the healthcare industry. Gartner’s “Hype Cycle for U.S. Healthcare Payers, 2020” report[i] has named HealthEdge as a Sample Vendor for the Next-Generation Core Administrative Systems category for ten consecutive years. With the recent backing of Blackstone, one of the world’s leading investment firms, and the acquisition of The Burgess Group®, and their innovative prospective payment integrity solution, Burgess Source®, HealthEdge continues to lead health transformation efforts and move our industry toward a boundary-less ecosystem.

[i] Gartner, Hype Cycle for U.S. Healthcare Payers, 2020, Analyst(s): Bryan Cole, Jeff Cribbs, Mandi Bishop, Published: 5 August 2020 ID: G00444809.