{"id":13257,"date":"2024-10-21T11:57:57","date_gmt":"2024-10-21T11:57:57","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=13257"},"modified":"2024-10-24T06:44:56","modified_gmt":"2024-10-24T06:44:56","slug":"12-opportunities-payers","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/12-opportunities-payers\/","title":{"rendered":"12 Key Opportunities Payers Can Leverage for Success"},"content":{"rendered":"\r\n<div id=\"rank-math-toc\" class=\"wp-block-rank-math-toc-block has-pale-ocean-gradient-background has-background\"><nav>\r\n<ul>\r\n<li><a href=\"#12-opportunities-payers-introduction\">12 Opportunities Payers: Introduction<\/a><\/li>\r\n<li><a href=\"#fa-qs\">FAQs<\/a>\r\n<ul>\r\n<li><a href=\"#1-what-is-the-biggest-challenge-for-payers-in-the-next-year\">1. What is the biggest challenge for payers in the next year?<\/a><\/li>\r\n<li><a href=\"#2-how-can-payers-improve-health-equity\">2. How can payers improve health equity?<\/a><\/li>\r\n<li><a href=\"#3-why-is-ai-important-for-payers\">3. Why is AI important for payers?<\/a><\/li>\r\n<\/ul>\r\n<\/li>\r\n<li><a href=\"#conclusion\">Conclusion<\/a><\/li>\r\n<\/ul>\r\n<\/nav><\/div>\r\n\r\n\r\n\r\n<h2 id=\"12-opportunities-payers-introduction\" class=\"wp-block-heading\">12 Opportunities Payers: Introduction<\/h2>\r\n\r\n\r\n\r\n<p>In the rapidly evolving healthcare landscape, payers have a unique opportunity to drive significant improvements in healthcare equity, patient outcomes, and operational efficiency over the next year. The focus for 2025 is on aligning cost-efficiency with high-quality care, embracing technology, and pushing the boundaries of <a href=\"https:\/\/bluebrix.health\/blogs\/role-of-technology-in-value-based-care\" target=\"_blank\" rel=\"noopener\">value-based care<\/a>.<\/p>\r\n\r\n\r\n\r\n<p id=\"1-balancing-cost-and-quality-of-care\" class=\"wp-block-heading\"><strong>1. Balancing Cost and Quality of Care<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Damanjeet Chaubey, MD, Vice President of Clinical Affairs, <a href=\"https:\/\/www.linkedin.com\/in\/damanjeet-chaubey-8492b0127\" target=\"_blank\" rel=\"noopener\">Clover Health<\/a><\/p>\r\n\r\n\r\n\r\n<p>One of the biggest challenges and opportunities payers face is balancing the cost of care with quality outcomes. With the aging population and expensive medical innovations, payers must focus on creating synergies across their organizations to provide timely interventions and value-based care. Aligning priorities within the organization is critical to delivering better care outcomes while managing escalating healthcare costs.<\/p>\r\n\r\n\r\n\r\n<p id=\"2-personalization-in-healthcare\" class=\"wp-block-heading\"><strong>2. Personalization in Healthcare<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Akrom Hossain, Senior Director of Healthcare Management, BCBS Illinois, Montana, New Mexico, Oklahoma &amp; Texas<\/p>\r\n\r\n\r\n\r\n<p>Personalization is becoming a game-changer in healthcare. Payers have the chance to make healthcare more accessible by integrating point solutions and using technology to offer personalized care experiences. The key lies in meeting members where they are, offering resources through preferred channels, and supporting providers in delivering holistic care that addresses whole health and wellness.<\/p>\r\n\r\n\r\n\r\n<p id=\"3-leveraging-ai-for-efficiency-and-growth\" class=\"wp-block-heading\"><strong>3. Leveraging AI for Efficiency and Growth<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Michael Hunn, CEO, CalOptima Health<\/p>\r\n\r\n\r\n\r\n<p>Artificial intelligence (AI) can transform network adequacy by improving primary care provider efficiency, addressing physician shortages, and streamlining administrative tasks like claims payments and same-day authorizations. By adopting dynamic AI technologies, payers can enhance their operational capabilities, providing more timely and accurate care while controlling costs.<\/p>\r\n\r\n\r\n\r\n<p id=\"4-providing-care-management-support\" class=\"wp-block-heading\"><strong>4. Providing Care Management Support<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Michael Kobernick, MD, Senior Medical Director, Health Plan Business, BCBS of Michigan<\/p>\r\n\r\n\r\n\r\n<p>Supporting members during difficult care journeys through robust care management programs is another vital opportunity. Payers need to offer tailored support, especially to members managing chronic conditions, by providing personalized resources and coordinating care to enhance their healthcare experiences and outcomes.<\/p>\r\n\r\n\r\n\r\n<p id=\"5-ensuring-stability-amidst-change\" class=\"wp-block-heading\"><strong>5. Ensuring Stability Amidst Change<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Hilary Marden-Resnik, President and CEO, UCare<\/p>\r\n\r\n\r\n\r\n<p>With significant regulatory changes looming, such as updates to Medicare Part D and the potential expiration of tax credits in the individual market, payers must act as stabilizing forces in the healthcare ecosystem. They need to support their members through these transitions, advocate for policies that maintain marketplace affordability, and re-enroll individuals who lost Medicaid coverage during redetermination processes.<\/p>\r\n\r\n\r\n\r\n<p id=\"6-adopting-ai-for-operational-and-clinical-success\" class=\"wp-block-heading\"><strong>6. Adopting AI for Operational and Clinical Success<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Ria Paul, MD, Chief Medical Officer, Santa Clara Family Health Plan<\/p>\r\n\r\n\r\n\r\n<p>AI\u2019s role in healthcare is expanding, and payers must adopt this technology in both operational and clinical areas. By using AI for claims processing, revenue cycle management, and risk stratification, payers can improve efficiency and accuracy. Care coordination will also benefit from AI, allowing payers to track members across the care continuum and reduce acute care admissions by promoting preventive care.<\/p>\r\n\r\n\r\n\r\n<p id=\"7-focusing-on-whole-health-and-value-based-care\" class=\"wp-block-heading\"><strong>7. Focusing on Whole Health and Value-Based Care<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Chandni Sud-Thavakumar, EdD, Vice President, Performance Operations, Mass Advantage<\/p>\r\n\r\n\r\n\r\n<p>Payers should shift their focus toward whole health, emphasizing value-based care models that prioritize specialty care. Building stronger collaborations between payers, networks, and members will be essential to improving health outcomes, retaining members, and delivering better healthcare experiences.<\/p>\r\n\r\n\r\n\r\n<p id=\"8-integrating-virtual-behavioral-health-services\" class=\"wp-block-heading\"><strong>8. Integrating Virtual Behavioral Health Services<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Philip Randall, Director, Population Health and Community Programs, Banner|Aetna<\/p>\r\n\r\n\r\n\r\n<p>Virtual behavioral health services present a significant opportunity for payers to improve member outcomes. By making these services more accessible and affordable, payers can help members manage chronic conditions and enhance their health literacy. A well-researched and integrated strategy will be crucial in getting these services to those who need them most.<\/p>\r\n\r\n\r\n\r\n<p id=\"9-improving-health-equity-initiatives\" class=\"wp-block-heading\"><strong>9. Improving Health Equity Initiatives<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Ilan Shapiro, MD, Chief Health Correspondent and Medical Affairs Officer, AltaMed Health Services<\/p>\r\n\r\n\r\n\r\n<p>Healthcare plans must engage communities to improve health outcomes. The next 12 months present an opportunity for payers to integrate health equity initiatives into their care models, ensuring that all populations receive appropriate care and resources tailored to their unique needs.<\/p>\r\n\r\n\r\n\r\n<p id=\"10-utilizing-ai-in-value-based-payment-models\" class=\"wp-block-heading\"><strong>10. Utilizing AI in Value-Based Payment Models<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Anthony Thompson, Senior Vice President, Healthcare Network Strategy, CDPHP<\/p>\r\n\r\n\r\n\r\n<p>Machine learning and generative AI are reshaping how payers design value-based contracts. These technologies allow payers to streamline payment models by analyzing patient data and predicting health risks, which helps prioritize preventive care and improve outcomes in value-based care environments.<\/p>\r\n\r\n\r\n\r\n<p id=\"11-addressing-health-disparities-and-equity\" class=\"wp-block-heading\"><strong>11. Addressing Health Disparities and Equity<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Johanna Vidal-Phelan, MD, Chief Medical Officer, UPMC Health Plan<\/p>\r\n\r\n\r\n\r\n<p>Advancing health equity should be a top priority for payers in the coming year. By incorporating equity goals into value-based care programs and collaborating with community organizations, payers can reduce health disparities and improve care for underserved populations. This focus on health equity will foster trust and lead to better resource allocation and care delivery.<\/p>\r\n\r\n\r\n\r\n<p id=\"12-collaborating-for-value-based-care-models\" class=\"wp-block-heading\"><strong>12. Collaborating for Value-Based Care Models<\/strong><\/p>\r\n\r\n\r\n\r\n<p>David Wang, MD, Chief Operating Officer, Mass Advantage<\/p>\r\n\r\n\r\n\r\n<p>With margin pressures increasing, payers must collaborate with providers to build sustainable value-based care models. Payers can better contain healthcare costs and ensure long-term success in delivering high-quality, affordable care by focusing on contracting and care transformation.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"fa-qs\" class=\"wp-block-heading\">FAQs<\/h2>\r\n\r\n\r\n\r\n<h4 id=\"1-what-is-the-biggest-challenge-for-payers-in-the-next-year\" class=\"wp-block-heading\">1. What is the biggest challenge for payers in the next year?<\/h4>\r\n\r\n\r\n\r\n<p>A. The biggest challenge for payers is balancing cost efficiency with delivering high-quality care while adapting to new regulations and technologies.<\/p>\r\n\r\n\r\n\r\n<h4 id=\"2-how-can-payers-improve-health-equity\" class=\"wp-block-heading\">2. How can payers improve health equity?<\/h4>\r\n\r\n\r\n\r\n<p>Payers can improve health equity by integrating equity goals into value-based care programs and collaborating with community organizations to address healthcare disparities.<\/p>\r\n\r\n\r\n\r\n<h4 id=\"3-why-is-ai-important-for-payers\" class=\"wp-block-heading\">3. Why is AI important for payers?<\/h4>\r\n\r\n\r\n\r\n<p>AI improves efficiency, accuracy, and personalization in healthcare, helping payers streamline operations, enhance care management, and design better payment models.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\r\n\r\n\r\n\r\n<p>The next year offers a range of opportunities for payers to reshape the healthcare landscape through innovation, technology, and a renewed focus on value-based care. From balancing costs while maintaining quality to leveraging AI for operational efficiency and health equity, payers are well-positioned to make a significant impact on patient outcomes and overall healthcare delivery. By adopting personalized care models, enhancing virtual health services, and building stronger collaborations with providers, payers can create sustainable systems that address the growing needs of diverse populations. These initiatives, when executed effectively, will ensure not only improved healthcare experiences for members but also long-term stability and growth within the healthcare ecosystem.<\/p>\r\n\r\n\r\n\r\n<p><span data-teams=\"true\"><span class=\"ui-provider a b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak\" dir=\"ltr\">Discover the latest <a id=\"menurv9\" class=\"fui-Link ___1q1shib f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1s184ao f1mk8lai fnbmjn9 f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn\" title=\"https:\/\/distilinfo.com\/healthplan\/\" href=\"https:\/\/distilinfo.com\/healthplan\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link payers&#039; news updates\"><strong>payers&#8217; news updates<\/strong><\/a> with a single click. 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Join our community today!<\/span><\/span><\/p>\r\n\r\n<p>&nbsp;<\/p>","protected":false},"excerpt":{"rendered":"<p>12 Opportunities Payers: Introduction In the rapidly evolving healthcare landscape, payers have a unique opportunity to drive significant improvements in&#8230; <a href=\"https:\/\/distilinfo.com\/healthplan\/12-opportunities-payers\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":13126,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[486,28],"class_list":{"0":"post-13257","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"tag-12-opportunities-payers","9":"tag-healthcare","10":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/13257"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=13257"}],"version-history":[{"count":10,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/13257\/revisions"}],"predecessor-version":[{"id":13328,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/13257\/revisions\/13328"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/13126"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=13257"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=13257"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=13257"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}