Health plans are feeling the pressure in a complex policy environment, with most executives polled in a new survey saying it's impacting costs and margins.
HealthEdge released the results from its annual survey of health insurance executives, and 85% of the 550 polled leaders said the policy pressures are making themselves felt financially. This year's survey marks a "seismic" shift in the top concerns for payer execs, as, while cost management remains the No. 1 issue, fears about the regulatory environment have risen.
The survey found that regulatory concerns were ranked above member satisfaction and workforce issues, both of which were listed as bigger than the policy environment in last year's report.
"The passage of the OBBBA has amplified the already-intense regulatory pressures payers face by introducing real-time eligibility requirements, stricter accountability standards, and new demands for administrative transparency," according to the report.
"These shifts not only disrupt legacy processes but also expose weaknesses in legacy systems that have a limited ability to share real-time data required for payers to meet rapidly changing requirements and succeed in emerging payment models," the HealthEdge analysts wrote.
In response to these pressures, insurers are leaning on technology to manage costs and regulatory changes, according to the survey. This starts with putting a greater focus on "IT and business alignment," which rose significantly in the survey this year.
A majority (60%) of those surveyed said they were investing in artificial intelligence and advanced analytics to automate certain processes as well as bulking up their use of digital tools to manage cost. And 51% said they were using AI or machine learning to prevent penalties tied to interoperability requirements.
Payers are also making investments in digital tools to improve member engagement. For example, 36% of the organizations in the survey currently offer a member-facing chatbot, but 50% of the surveyed executives said they are committed to rolling one out in the next year.
Nearly half (44%) of executives said they're diving into virtual concierge and navigation services, while 43% are prioritizing digital health assessments. In addition, 39% said they are putting a focus on automatic adjudication to improve the accuracy of claims payments, and 38% said they're looking to greater personalization through data sharing and departmental integration.
"Health plan leaders are in the untenable position of trying to control costs, maintain pace with regulatory change and meet the rising expectations of both members and providers,” said Alan Stein, chief solutions officer at HealthEdge, in a press release.
"There are difficult decisions on the horizon in the coming year, but it is clear payers are embracing modern, connected and scalable technology and services to support collaborative, data-sharing partnerships," Stein said. "AI has rapidly emerged as the primary strategy to help combat rising costs and meet regulatory requirements, and investments around technology modernization, interoperability and automation reflect that."