3 Strategic Opportunities for Health Plans using Modern Healthcare Technology
According to the Annual Payer Market Planning Report from HealthEdge®, technology modernization is one of the top concerns for health plan leaders. Modern healthcare technologies are characterized by their interoperability and workflow optimization, which helps health plans streamline processes while enhancing member outcomes and experiences.
In the survey, health plan leaders made it clear that their priorities for 2025 revolve around enhancing integrated solutions, improving data securtiy, and leveraging artificial intelligence (AI). Over the past four years, health plans have made significant investments in technology, including telehealth, digital care management, and payment integrity. Now, their focus has shifted to consolidating these solutions and bringing processes in-house. By implementing integrated and interoperable systems, they aim to maximize efficiency and strengthen security measures.
Modernize Existing Healthcare Technologies
Modern Core Administrative Processing Systems (CAPS) have gained prominence as a top investment priority for 50% of payers in the upcoming year. These advanced systems are essential for maximizing operational efficiency and maintaining competitiveness. Health plans are increasingly adopting CAPS solutions that feature comprehensive integrations and robust functionalities, enabling them to streamline workflows and reduce costs.
Legacy CAPS solutions often fail to provide the scalability and interoperability that health plans need to thrive in the competitive healthcare environment. Next-generation CAPS like HealthRules® Payer delivers capabilities like hybrid cloud delivery, business-friendly configuration, and adaptable modern architecture. These advanced features enable health plans to seamlessly integrate CAPS with other solutions, ensuring interoperability across the entire ecosystem. This integration allows health plans to consolidate solutions and bring processes in-house, leading to more efficient operations and better control over their data and workflows.
Enhance Data Security Measures
According to the recent HealthEdge report, 46 percent of health plan executives listed “security” as their highest priority for 2025 when it comes to technology modernization. This is no surprise, considering there have been more than 380 healthcare cyber-attacks reported in 2024 so far.
Health plans are increasingly aware that working with technology vendors who embed privacy and security into their product designs is essential not only for compliance but also to preserve members’ trust.
At HealthEdge, we build data security into the foundations of all our solutions. Our teams identify risks, implement security measures, and develop processes that help ensure proper handling of protected health information. These comprehensive data security functions support operational transparency and encourage trust in your organization.
Incorporate Artificial Intelligence (AI) Capabilities
Piloting enterprise artificial intelligence (AI) use cases has emerged as one of the top three priorities for health plans when it comes to technology modernization. With 26% of health plan leaders focusing on this initiative, innovation is undeniably on the horizon.
AI is revolutionizing healthcare across multiple functions. From enhancing customer service through chatbots and virtual assistants to streamlining human resources processes, the applications for AI tools in healthcare are vast. These AI solutions can significantly enhance customer satisfaction by providing timely and accurate support.
Data is the lifeblood of healthcare, and AI empowers organizations to harness it effectively. Through advanced data analysis techniques, health plans can uncover actionable insights, improve patient outcomes, and drive strategic decision-making. AI’s ability to process vast amounts of data quickly enables healthcare organizations to remain agile in a dynamic environment.
The future of healthcare is inextricably linked to technology and AI. To remain competitive, health plans must invest strategically in these areas. By prioritizing security, modernizing technology, and harnessing the power of AI, healthcare organizations can enhance their operations, deliver better member experiences, and achieve long-term success.
Download the complimentary HealthEdge® Annual Payer Market Planning Report 2025 to gain proprietary insights into the strategic priorities of more than 450 health plan executives from across the U.S.
