Skip to main content

Becoming a Digital Payer: Constantly Striving for Higher Quality

HealthEdge has identified five key attributes that drive digital payers, enabling them to rise above the competition and lead the way to better outcomes across the entire healthcare delivery system.

Digital Health Payers focus on:

  1. Improving end-user and member centricity
  2. Achieving higher levels of quality
  3. Increasing transparency
  4. Advancing customer service
  5. Reducing transaction costs

In this five-part blog post series, we’re diving deeper into each attribute, delivering resources, information, and insights to enable health plans to transform into digital health payers. As we continue the conversation around what it means to be a digital payer, this discussion focuses on ever-increasing quality.

Achieving Higher Levels of Quality

While high quality care and service is top of mind for all health insurance payers, digital payers constantly strive to improve quality and do so by leveraging modern, digital platforms. For these organizations, quality is a mind-set in which every aspect of the business focuses on improving.

As traditional payers transform into digital payers, there are three key areas in which the organization should focus on improving quality that will deliver the greatest impact on the entire healthcare delivery system – communication, data, and care.

Improving Quality in Communications

Today, communication occurs through a variety of channels including portals, phone, email, telehealth, and face-to-face conversation. Without a single view of these communications, key stakeholders can easily be left in the dark, resulting in less accurate claims and reimbursements and jeopardizing optimal health outcomes for members.

To improve quality in communication, digital payers can:

  • Provide access to accurate, real-time information to those who need it
  • Consolidate or integration communication channels to reduce the number of touch points
  • Make real-time data more accessible to care managers and customer service team members facilitating communication between stakeholders
  • Leverage true integration between digital health solutions across the entire health delivery system.

The CMS National Quality Strategy includes a goal of the program to Embrace the digital age, explaining that quality can increase when organizations, “Ensure timely, secure, seamless communication and care coordination between providers, plans, payers, community organizations, and patients through interoperable, shared, and standardized digital data across the care continuum to achieve desired outcomes and provide patients direct access to their information. 

In addition to HealthEdge’s inherent capability to share real-time data across lines of business, functional departments, and third-party systems, Wellframe (HealthEdge’s digital member engagement platform) takes collaboration one step further by facilitating real-time communication and insights between care managers, customer service representatives, and members.

Improving Data Quality

Digital payers strive for excellence in making high-quality, accurate data more accessible. The result? More accurate, trustworthy data is available for better contract negotiations, more automated claims processing, and smarter business decisions.

Accurate data also improves claims accuracy, saving time and cutting costs due to less rework and fewer under/over payments. Digital health payers use technology and innovation to improve data quality through:

  • Establishing a central source of truth and data standards to create and maintain quality data
  • Integrating disparate systems to improve access to accurate data
  • Leveraging automation to improve accuracy and eliminate manual steps in which data discrepancies could be introduced
  • Implementing innovative tools to extract, use, and share valuable data across the care continuum.

Improving Care Quality

Health plans have an opportunity to positively impact care quality as a digital payer. Digital payers use technology and information to constantly improve quality of care for their members by streamlining processes, improving care coordination, and enabling better care decisions.

Digital Payers can improve care quality by:

  • Connecting with members in meaningful ways, delivering information and guidance at the right time
  • Improving care decisions by enabling greater access to valuable health and benefit information to care managers and providers when they need it
  • Facilitating better care coordination between members, providers, caregivers, and members
  • Leveraging technology to improve member engagement through mobile-friendly applications and portals.

As digital payers strive for ever-increasing quality across their organizations, they enjoy the added benefits of more informed provider networks, lower operating costs, higher efficiencies, and better outcomes for their members.

Learn more about how HealthEdge can help your health plan improve quality through digital transformation at or [email protected].